Healthcare Provider Details

I. General information

NPI: 1154449809
Provider Name (Legal Business Name): JANAN R. LANE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 E US 412 HWY STE C
SILOAM SPRINGS AR
72761
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD SUITE 300
FRANKLIN TN
37067-2626
US

V. Phone/Fax

Practice location:
  • Phone: 479-215-3090
  • Fax: 479-549-4059
Mailing address:
  • Phone: 615-778-4066
  • Fax: 615-778-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4423
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberE10185
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: