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General NPI Number Information
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NPI Number | 1003127465
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Entity Type | Individual
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Provider Name | RACHAEL E. VANDEN LANGENBERG D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 3263 EATON RD
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City | GREEN BAY
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State | WI
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Zip | 54311-6830
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Country | US
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Telephone | 920-433-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 3263 EATON RD
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City | GREEN BAY
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State | WI
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Zip | 54311-6830
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Country | US
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Telephone | 920-433-6700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT013624
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS015861
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 61517-21
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License Number State | WI
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