Individual
MS. SHANNON LESLEY LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC, CNS
Contact information
Practice address
BROOKE ARMY MEDICAL CENTER, 3551 ROGER BROOKE DRIVE, SAN ANTONIO, TX 78234-4504
(210) 916-3160
Mailing address
19TH MEDICAL GROUP 1090 ARNOLD DRIVE, LITTLE ROCK AFB, AR 72099-4933
(501) 987-7446
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
NP95009977
CA
363LP0200X
Pediatric Nurse Practitioner
Primary
1013771
TX
Other
Enumeration date
10/02/2018
Last updated
08/04/2023
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