Healthcare Provider Details

I. General information

NPI: 1598599698
Provider Name (Legal Business Name): MEGAN VIRGINIA LANG PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 LAUREL ST
ANCHORAGE AK
99508-5389
US

IV. Provider business mailing address

4048 LAUREL ST
ANCHORAGE AK
99508-5389
US

V. Phone/Fax

Practice location:
  • Phone: 907-223-3879
  • Fax:
Mailing address:
  • Phone: 907-223-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number229224
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: