Individual
SAMANTHA RAE LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1072 N LIBERTY ST STE 203, BOISE, ID 83704
(208) 302-5800
(208) 302-5855
Mailing address
2115 ENELL ST, IDAHO FALLS, ID 83402-2911
(208) 302-5800
(208) 302-5855
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1432
ID
Other
Enumeration date
10/27/2016
Last updated
06/10/2019
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