Healthcare Provider Details

I. General information

NPI: 1043546443
Provider Name (Legal Business Name): SANDRA LANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAIN ST
FOLLANSBEE WV
26037-1202
US

IV. Provider business mailing address

1400 MAIN ST
FOLLANSBEE WV
26037-1202
US

V. Phone/Fax

Practice location:
  • Phone: 304-670-5534
  • Fax:
Mailing address:
  • Phone: 304-670-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010453
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCOA14433NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: