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NPI Code Detail

MEDICARE: ALICIA LANGE RN

MEDICARE:   ALICIA  LANGE  RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN9204129FL

General Provider Information

NPI Number : 1972908507
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA LANGE RN
Provider Business Mailing Address
First Line : 5150 NW MILNER DR
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34983-3392
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5150 NW MILNER DR
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34983-3392
Country : US
Telephone Number : 772-201-6174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2014
Last Update Date : 10/24/2014

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Directions to “ ALICIA LANGE RN” Practice Location

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