Individual
MRS. KELLI L LANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
17482 AMAGANSET WAY, TUSTIN, CA 92780-2510
(714) 292-1398
Mailing address
17482 AMAGANSET WAY, TUSTIN, CA 92780-2510
(714) 292-1398
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
545992
CA
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L-85403
CA
Other
Enumeration date
03/24/2017
Last updated
03/24/2017
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