Healthcare Provider Details

I. General information

NPI: 1730097841
Provider Name (Legal Business Name): JORDIS NEVAEH LANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MARBLE BLUFFS BLVD
WENTZVILLE MO
63385-3853
US

IV. Provider business mailing address

216 MARBLE BLUFFS BLVD
WENTZVILLE MO
63385-3853
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-5010
  • Fax: 636-443-2698
Mailing address:
  • Phone: 636-947-5010
  • Fax: 636-443-2698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1380760
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: