Healthcare Provider Details

I. General information

NPI: 1720107089
Provider Name (Legal Business Name): CHERYL LANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MILLWOOD ST
CARO MI
48723-1630
US

IV. Provider business mailing address

747 SAND RD
PORT AUSTIN MI
48467-9754
US

V. Phone/Fax

Practice location:
  • Phone: 989-672-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704123502
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704123502
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: