Provider Demographics
NPI:1962708156
Name:LANG, JAMIE SUE (NP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:SUE
Last Name:LANG
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:330 N WABASH
Mailing Address - Street 2:STE G20
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7616
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:1406 W BELLA DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5229
Practice Address - Country:US
Practice Address - Phone:765-660-7720
Practice Address - Fax:765-662-4493
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2020-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71003507A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
12283885OtherCAQH
IN000001261336OtherANTHEM
IN100343010Medicaid