Healthcare Provider Details

I. General information

NPI: 1467142026
Provider Name (Legal Business Name): AMANDA NORA LANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-4495
  • Fax: 402-955-4131
Mailing address:
  • Phone: 402-955-4495
  • Fax: 402-955-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37335
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: