Provider Demographics
NPI:1023681129
Name:LANE, KRISTINA DANOVICH (NP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DANOVICH
Last Name:LANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E HAMPDEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2517
Mailing Address - Country:US
Mailing Address - Phone:303-789-4968
Mailing Address - Fax:
Practice Address - Street 1:180 E HAMPDEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2517
Practice Address - Country:US
Practice Address - Phone:303-789-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003078-C-NP363LW0102X
CO0997244-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty