Individual
JAMIE SUE LANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1406 W BELLA DR, MARION, IN 46953-5229
(765) 660-7720
(765) 662-4493
Mailing address
330 N WABASH, STE G20, MARION, IN 46952-2600
(765) 660-7616
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71003507A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001261336
ANTHEM
IN
05
—
100343010
—
IN
01
—
12283885
CAQH
—
Enumeration date
02/04/2011
Last updated
10/21/2020
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