Healthcare Provider Details

I. General information

NPI: 1013324367
Provider Name (Legal Business Name): LANE MARIE BRYANT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANE MARIE ERICKSON P.A.

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 E EGBERT ST
BRIGHTON CO
80601-2475
US

IV. Provider business mailing address

203 S ROLLIE AVE BILLING DEPT - CREDENTIALIST
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-659-4000
  • Fax: 303-659-9306
Mailing address:
  • Phone: 303-286-4560
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0003983
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: