Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 35052191 | OH |
Y | 207QS0010X | Family Doctor - Sports Medicine | ME136355 | FL |
NPI | 1023087467 |
---|---|
Provider Name | Sandra Evelyn Lane |
First Address | Punta Gorda, FL 33950-3823 |
Second Address | Punta Gorda, FL 33950-3823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 14/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000209373 | ANTHEM (01) | |
000000226360 | ANTHEM (01) | |
010064146 | RAILROAD MEDICARE (01) | |
0671269 | (05) | OH |
2300473 | UNITED HEALTHCARE (01) | |
310846816007 | PRUDENTIAL (01) | |
311157926SAL | SUMMIT (01) | |
4015568 | AETNA (01) | |
6567 | NATIONWIDE (01) | |
D32431 | (02) | |
P00131420 | CIGNA (01) |