Healthcare Provider Details

I. General information

NPI: 1972369262
Provider Name (Legal Business Name): ANGELA K LANG PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14221 E 4TH AVE STE 2-126
AURORA CO
80011-8735
US

IV. Provider business mailing address

17667 E KETTLE PL
CENTENNIAL CO
80016-1878
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4779
  • Fax: 833-941-5047
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0108592
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: