Healthcare Provider Details

I. General information

NPI: 1275173858
Provider Name (Legal Business Name): KARIS A LANGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PINE LAKE RD STE 120
LINCOLN NE
68516-5497
US

IV. Provider business mailing address

3901 PINE LAKE RD STE 120
LINCOLN NE
68516-5497
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-1212
  • Fax: 402-328-0961
Mailing address:
  • Phone: 402-420-1212
  • Fax: 402-328-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2423
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: