Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP140856 | TX |
NPI | 1134688757 |
---|---|
Provider Name | Nancy Elizabeth Lane |
First Address | Plantation, FL 33322-4113 |
Second Address | Flower Mound, TX 75028-2464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2019 |
Last Update Date | 13/03/2019 |