Individual
MARY LANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2024 S 6TH ST, BRAINERD, MN 56401-4529
(218) 828-7100
(218) 828-7194
Mailing address
2024 S 6TH ST, BRAINERD, MN 56401-4529
(218) 828-7100
(218) 828-7194
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0854
MN
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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