KRYSTLE NICOLE LANGE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

ACTIVE

Business

Title

First Name

KRYSTLE

Middle

NICOLE

Last Name

LANGE

Business Name

KRYSTLE NICOLE LANGE DO

Original Issue Date

08/24/2017

Effective Date

06/28/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/28/2023