Provider Demographics
NPI:1710707054
Name:LANE, MISTY GINELLE
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:GINELLE
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 1:18505 NORTHLAND DR LOT 76
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9770
Mailing Address - Country:US
Mailing Address - Phone:541-219-1987
Mailing Address - Fax:
Practice Address - Street 1:18505 NORTHLAND DR LOT 76
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9770
Practice Address - Country:US
Practice Address - Phone:541-219-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)