Provider Demographics
NPI:1730794751
Name:LANE, WILLIAM JAY
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAY
Last Name:LANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WESTGATE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-1144
Mailing Address - Country:US
Mailing Address - Phone:513-846-0751
Mailing Address - Fax:
Practice Address - Street 1:410 WESTGATE DR UNIT A
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-1144
Practice Address - Country:US
Practice Address - Phone:513-846-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care