Individual
LANGE CLANCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
81177-21
WI
207Q00000X
Family Medicine Physician
MRO-1926
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/04/2018
Last updated
02/13/2026
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