Healthcare Provider Details

I. General information

NPI: 1932040177
Provider Name (Legal Business Name): LANE LEAVENS-NICHOLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

9170 OCCIDENTAL RD
SEBASTOPOL CA
95472-6441
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: