MEDICARE: KAREN LANE MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0000X	Pain Management Registered Nurse	311949	CA

General Provider Information

NPI Number	:	1316287436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LANE MSN

Provider Business Mailing Address
First Line	:	3040 UDALL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-1654
Country	:	US
Telephone Number	:	619-806-0928
Fax Number	:	619-523-4099

Provider Business Practice Location Address
First Line	:	4305 GESNER ST STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6673
Country	:	US
Telephone Number	:	619-806-0928
Fax Number	:	619-523-4099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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Directions to “ KAREN LANE MSN” Practice Location

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