Healthcare Provider Details

I. General information

NPI: 1295704740
Provider Name (Legal Business Name): ELIZABETH BARBARA LAINE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E LUGONIA AVE
REDLANDS CA
92374-2550
US

IV. Provider business mailing address

10700 DEERFIELD DR
CHERRY VALLEY CA
92223-5599
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-4872
  • Fax:
Mailing address:
  • Phone: 951-845-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number338761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: