Provider Demographics
NPI:1932955358
Name:LANG, PAIGE BERNIECE (PA-C)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:BERNIECE
Last Name:LANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:BERNIECE
Other - Last Name:RENFROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:606 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1523
Mailing Address - Country:US
Mailing Address - Phone:660-882-3955
Mailing Address - Fax:660-882-3972
Practice Address - Street 1:606 E SPRING ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1523
Practice Address - Country:US
Practice Address - Phone:660-882-3955
Practice Address - Fax:660-882-3972
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024014052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant