Healthcare Provider Details

I. General information

NPI: 1548374705
Provider Name (Legal Business Name): SHELLEY MARIE LANE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SW 6TH AVE
TOPEKA KS
66606-2806
US

IV. Provider business mailing address

3500 SW 6TH AVE
TOPEKA KS
66606-2806
US

V. Phone/Fax

Practice location:
  • Phone: 785-235-0335
  • Fax: 785-235-0368
Mailing address:
  • Phone: 785-235-0335
  • Fax: 785-235-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45097
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: