Healthcare Provider Details

I. General information

NPI: 1922809623
Provider Name (Legal Business Name): JENNIFER CHRISTINE LANGE MS, RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

201 NE 1ST ST APT 204
OKLAHOMA CITY OK
73104-4079
US

V. Phone/Fax

Practice location:
  • Phone: 562-477-6371
  • Fax:
Mailing address:
  • Phone: 562-477-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1401X
TaxonomyPediatric Critical Care Nutrition Registered Dietitian
License Number86296501
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86296501
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86296501
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: