MEDICARE: JACOB PLANGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	RN2301226	MA
2	363LF0000X	Family Nurse Practitioner	F12250206	MA

General Provider Information

NPI Number	:	1265278337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB PLANGE

Provider Business Mailing Address
First Line	:	60 ADELAIDE ST
Second Line	:
City	:	HUDSON
State	:	NH
Zip	:	03051-4357
Country	:	US
Telephone Number	:	781-775-0302
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 ADELAIDE ST
Second Line	:
City	:	HUDSON
State	:	NH
Zip	:	03051-4357
Country	:	US
Telephone Number	:	781-775-0302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	12/10/2025

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Directions to “ JACOB PLANGE ” Practice Location

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