Basic Information
| Provider Information | |||||||||
| NPI: | 1669756177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANE | ||||||||
| FirstName: | MCTISA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1159 HUFFMAN MILL RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272158862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362238333 | ||||||||
| FaxNumber: | 8555404722 | ||||||||
| Practice Location | |||||||||
| Address1: | 124 CINDER CROSS WAY | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196259818 | ||||||||
| FaxNumber: | 9193078017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 12/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC1500X | 225163 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health | 363LF0000X | 5005342 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.