MEDICARE: DR. MICHAEL JENNINGS LANE SR. DNP PMHNP-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	163WE0003X	Emergency Registered Nurse	041354134	IL
2	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	28230854A	IN
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209023083	IL
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71011081A	IN

General Provider Information

NPI Number	:	1457932337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JENNINGS LANE SR. DNP PMHNP-BC

Provider Business Mailing Address
First Line	:	10110 DONALD S POWERS DR STE 101C
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-4070
Country	:	US
Telephone Number	:	269-250-8013
Fax Number	:

Provider Business Practice Location Address
First Line	:	10110 DONALD S POWERS DR STE 101C
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-4070
Country	:	US
Telephone Number	:	269-250-8013
Fax Number	:	877-326-2856

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

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	02/26/2025

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Directions to “ DR. MICHAEL JENNINGS LANE SR. DNP PMHNP-BC” Practice Location

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