Provider Demographics
NPI:1902188980
Name:LANGE, AMBER L (NP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:LANGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 HACKETT BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1756
Mailing Address - Country:US
Mailing Address - Phone:518-465-3318
Mailing Address - Fax:
Practice Address - Street 1:62 HACKETT BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1756
Practice Address - Country:US
Practice Address - Phone:518-465-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421043363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY421043OtherNYS LICENSE #