Healthcare Provider Details

I. General information

NPI: 1679598676
Provider Name (Legal Business Name): DEBORAH JEAN LANE MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD STE 300
INDIANAPOLIS IN
46260-2074
US

IV. Provider business mailing address

6270 N PARK AVE
INDIANAPOLIS IN
46220-1846
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-3867
  • Fax: 317-338-9544
Mailing address:
  • Phone: 812-890-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: