1154982783 NPI number — ALICIA JEAN LANE MSN, RN, FNP-C

Table of content: ALICIA JEAN LANE MSN, RN, FNP-C (NPI 1154982783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154982783 NPI number — ALICIA JEAN LANE MSN, RN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
ALICIA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154982783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1014 WESTMORELAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49006-5544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-494-0833
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWAGIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49047-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-783-3052
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704343669 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com