Provider Demographics
NPI:1699488825
Name:LANGE, ALYSSA (CNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:BOYUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1015 4TH AVE N STE 206
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1178
Mailing Address - Country:US
Mailing Address - Phone:612-238-0034
Mailing Address - Fax:
Practice Address - Street 1:1015 4TH AVE N STE 206
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1178
Practice Address - Country:US
Practice Address - Phone:612-238-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAG02230034363LP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care