Provider Demographics
NPI:1295482701
Name:LANE, KIRSTEN (BAI CD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:BAI CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 S 600 E
Mailing Address - Street 2:
Mailing Address - City:AVILLA
Mailing Address - State:IN
Mailing Address - Zip Code:46710-9756
Mailing Address - Country:US
Mailing Address - Phone:260-460-7686
Mailing Address - Fax:
Practice Address - Street 1:1625 S 600 E
Practice Address - Street 2:
Practice Address - City:AVILLA
Practice Address - State:IN
Practice Address - Zip Code:46710-9756
Practice Address - Country:US
Practice Address - Phone:260-460-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1444808KL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula