Healthcare Provider Details

I. General information

NPI: 1861104929
Provider Name (Legal Business Name): ALYSHA LANGE DNP, APNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 CHERRYVALE PL UNIT 2
APPLETON WI
54913-9459
US

IV. Provider business mailing address

3639 CHERRYVALE PL UNIT 2
APPLETON WI
54913-9459
US

V. Phone/Fax

Practice location:
  • Phone: 715-927-4234
  • Fax:
Mailing address:
  • Phone: 715-927-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13308
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: