MEDICARE: DOUGLAS LANGEBERG RN

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	163WC0400X	Case Management Registered Nurse	122798-30	WI
2	163WI0500X	Infusion Therapy Registered Nurse	122798-30	WI
3	163WH0200X	Home Health Registered Nurse	122798-30	WI

General Provider Information

NPI Number	:	1346137619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS LANGEBERG RN

Provider Business Mailing Address
First Line	:	2863 MORROW RD
Second Line	:
City	:	OMRO
State	:	WI
Zip	:	54963-9738
Country	:	US
Telephone Number	:	920-279-8042
Fax Number	:

Provider Business Practice Location Address
First Line	:	2863 MORROW RD
Second Line	:
City	:	OMRO
State	:	WI
Zip	:	54963-9738
Country	:	US
Telephone Number	:	920-279-8042
Fax Number	:

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

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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