Provider Demographics
NPI:1912903113
Name:LANG REE, JENNIFER (PNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:LANG REE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10956 DONNER PASS RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4860
Mailing Address - Country:US
Mailing Address - Phone:530-587-3523
Mailing Address - Fax:530-582-6192
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:STE 130
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4860
Practice Address - Country:US
Practice Address - Phone:530-587-3523
Practice Address - Fax:530-582-6190
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11027363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA260026968OtherTAX IDENTIFICATION NUMBER
CAGR0075020Medicaid
CAZHCPP486OtherBLUE CROSS OF CALIFORNIA
CAZZZ52949ZOtherBLUE SHIELD OF CALIFORNIA