Basic Information
| Provider Information | |||||||||
| NPI: | 1043782931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | JOAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 735 STENNETT RD | ||||||||
| Address2: | |||||||||
| City: | WHEELERSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456948928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404644268 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 902 GALLIA ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405292125 | ||||||||
| FaxNumber: | 7405292126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2018 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | APRN.CNP.024020 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | APRN.CNP.024020 | 01 | OH | OHIO BOARD OF NURSING | OTHER |