Healthcare Provider Details

I. General information

NPI: 1548394190
Provider Name (Legal Business Name): SARA JANE LANG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CHANNEL DR
JUNEAU AK
99801-7837
US

IV. Provider business mailing address

PO BOX 35284
JUNEAU AK
99803-5284
US

V. Phone/Fax

Practice location:
  • Phone: 907-463-3471
  • Fax: 907-364-4442
Mailing address:
  • Phone: 907-723-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number17280
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111598
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: