NPI 1225513591 · live from the CMS NPI Registry
Shannon Lesley Lange, CPNP-PC, CNS
Nurse Practitioner, Pediatrics in San Antonio, TX. National Provider Identifier 1225513591, active.
NPI record
| NPI | 1225513591 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234 |
| Practice phone | 210-916-3160 |
| Mailing address | 19th Medical Group 1090 Arnold Drive, Little Rock Afb, AR 72099 |
| Enumerated | October 2, 2018 |
| Last updated | August 4, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatrics | 208000000X | NP95009977 (CA) |
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 1013771 (TX) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.