Provider Demographics
NPI:1265197792
Name:LANE, BRANDY MICHELLE
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:MICHELLE
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ROYAL VISTA CV
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9143
Mailing Address - Country:US
Mailing Address - Phone:501-352-2422
Mailing Address - Fax:
Practice Address - Street 1:12 ROYAL VISTA CV
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9143
Practice Address - Country:US
Practice Address - Phone:501-352-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula