Healthcare Provider Details

I. General information

NPI: 1275800989
Provider Name (Legal Business Name): KAY L LANGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY L KOWALSKI RN

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 E HIGHWAY 33 SUITE 1
CRETE NE
68333-5076
US

IV. Provider business mailing address

995 E HIGHWAY 33 SUITE 1
CRETE NE
68333-5076
US

V. Phone/Fax

Practice location:
  • Phone: 402-826-6689
  • Fax: 402-826-4101
Mailing address:
  • Phone: 402-826-6689
  • Fax: 402-826-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number42328
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: