Healthcare Provider Details

I. General information

NPI: 1578011664
Provider Name (Legal Business Name): LEAH LANE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S HAVANA ST
AURORA CO
80014-1618
US

IV. Provider business mailing address

10915 W 85TH PL
ARVADA CO
80005-4799
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3045
  • Fax: 303-338-3710
Mailing address:
  • Phone: 512-775-9649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0195022
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: