Provider Demographics
NPI:1487767091
Name:LANE, MARY ANNE (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:LANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 LUDIE BROWN RD
Mailing Address - Street 2:
Mailing Address - City:CHINQUAPIN
Mailing Address - State:NC
Mailing Address - Zip Code:28521-8638
Mailing Address - Country:US
Mailing Address - Phone:910-285-4651
Mailing Address - Fax:
Practice Address - Street 1:340 SEMINARY ST.
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349
Practice Address - Country:US
Practice Address - Phone:910-296-2130
Practice Address - Fax:910-296-2139
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC063889163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse