| NPI | 1871642249 |
|---|---|
| Former Name | TYANN C LANGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1520) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2014-12-03 |