MEDICARE: KRYSTAL J LANE FNP-BC

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	363LF0000X	Family Nurse Practitioner	17563	WI
2	363L00000X	Nurse Practitioner	209-033232	IL
3	390200000X	Student in an Organized Health Care Education/Training Program
4	363LF0000X	Family Nurse Practitioner	21101	SC
5	363L00000X	Nurse Practitioner	21101	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437684271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL J LANE FNP-BC

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 JOY DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-8402
Country	:	US
Telephone Number	:	803-322-6548
Fax Number	:

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

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	04/16/2026

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