Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F420123-1 | NY |
NPI | 1083960066 |
---|---|
Provider Name | Patsy H Lane |
First Address | Mayville, NY 14757-1095 |
Second Address | Mayville, NY 14757-1095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2012 |
Last Update Date | 27/07/2012 |