Basic Information
| Provider Information | |||||||||
| NPI: | 1326506122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANE | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | ERIN MICHELE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 449 ROUTE 146 STE 101 | ||||||||
| Address2: | |||||||||
| City: | HALFMOON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120653239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183733924 | ||||||||
| FaxNumber: | 5183733808 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PATROON CREEK BLVD STE 1 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122065014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184890044 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2019 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F309109-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 05552396 | 05 | NY | MEDICAID |