Healthcare Provider Details

I. General information

NPI: 1710804349
Provider Name (Legal Business Name): ALEXANDRIA NICOLE LANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 WSW BUILDING 303 E KEARSLEY ST
FLINT MI
48502
US

IV. Provider business mailing address

940 WESTMOOR DR NW
GRAND RAPIDS MI
49504-3853
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-3147
  • Fax:
Mailing address:
  • Phone: 616-328-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: