Healthcare Provider Details

I. General information

NPI: 1356179584
Provider Name (Legal Business Name): LANE FALCON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 4TH ST
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

102 HARPER AVE
LAFAYETTE LA
70506-5415
US

V. Phone/Fax

Practice location:
  • Phone: 318-393-5075
  • Fax:
Mailing address:
  • Phone: 318-393-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN158972
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: