Provider Demographics
NPI:1861104929
Name:LANGE, ALYSHA (DNP, APNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:ALYSHA
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:DNP, APNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 CHERRYVALE PL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9459
Mailing Address - Country:US
Mailing Address - Phone:715-927-4234
Mailing Address - Fax:
Practice Address - Street 1:3639 CHERRYVALE PL UNIT 2
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9459
Practice Address - Country:US
Practice Address - Phone:715-927-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily