Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-138341 | IL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036-138341 | IL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101018351 | MI |
NPI | 1366756793 |
---|---|
Provider Name | Dr. Jennifer C Lane |
First Address | Milwaukee, WI 53278-8866 |
Second Address | Rockford, IL 61107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2010 |
Last Update Date | 19/02/2021 |