Healthcare Provider Details

I. General information

NPI: 1497752943
Provider Name (Legal Business Name): TERRY ANN LANE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N 3RD AVE STE 101 FAMILY HEALTH CENTER
SANDPOINT ID
83864-1594
US

IV. Provider business mailing address

1508 MATHISON DR
SANDPOINT ID
83864-8353
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-1435
  • Fax: 208-263-4580
Mailing address:
  • Phone: 208-263-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-236A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: