Healthcare Provider Details

I. General information

NPI: 1700702370
Provider Name (Legal Business Name): MALLORIE LANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 NEWTON RD
IOWA CITY IA
52242
US

IV. Provider business mailing address

1438 ABER AVE
IOWA CITY IA
52246-4700
US

V. Phone/Fax

Practice location:
  • Phone: 319-335-6707
  • Fax:
Mailing address:
  • Phone: 763-645-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: