Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 44890 | KS |
NPI | 1013010560 |
---|---|
Provider Name | Mrs. Brenda K Lane |
First Address | Olathe, KS 66062 |
Second Address | Overland Park, KS 66215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P07224 | (02) | KS |