Healthcare Provider Details

I. General information

NPI: 1326378480
Provider Name (Legal Business Name): TONI LANE RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 NORRIS CANYON RD
SAN RAMON CA
94583-5400
US

IV. Provider business mailing address

779 BROOKSIDE DR
DANVILLE CA
94526-4957
US

V. Phone/Fax

Practice location:
  • Phone: 925-275-8850
  • Fax:
Mailing address:
  • Phone: 925-518-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN446514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: