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NPI Code Detail

MEDICARE: KATHLEEN M LANE FNP

MEDICARE: KATHLEEN M LANE FNP
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
1363LF0000XFamily Nurse Practitioner309939CA

General Provider Information

NPI Number : 1578837506
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN M LANE FNP
Provider Business Mailing Address
First Line : 12591 CRYSTAL RANCH RD
Second Line :
City : MOORPARK
State : CA
Zip : 93021-2913
Country : US
Telephone Number : 805-523-7694
Fax Number :
Provider Business Practice Location Address
First Line : 5297 MAUREEN LN
Second Line :
City : MOORPARK
State : CA
Zip : 93021-7125
Country : US
Telephone Number : 805-531-6481
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2012
Last Update Date : 03/08/2012

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