Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 229867 | NC |
NPI | 1003344045 |
---|---|
Provider Name | Stacy Joelle Lane |
First Address | Raleigh, NC 27607-6011 |
Second Address | Chapel Hill, NC 27599-7064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2017 |
Last Update Date | 02/06/2017 |