Individual provider · Type 1 NPI
Shannon Lesley Lange, CPNP-PC, CNS
Pediatric Nurse Practitioner · San Antonio, TX
NPI number
1225513591
Active
Practice location
Brooke Army Medical Center, 3551 Roger Brooke Drive
San Antonio, TX 78234-4504
Mailing address
19th Medical Group 1090 Arnold Drive
Little Rock Afb, AR 72099-4933
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatrics Physician | 208000000X | NP95009977 (CA) |
| Pediatric Nurse Practitioner Primary | 363LP0200X | 1013771 (TX) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1225513591
Shannon Lesley Lange, CPNP-PC, CNS's National Provider Identifier is 1225513591, issued on Oct 2, 2018. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in San Antonio, TX. The record was last updated on Aug 4, 2023.