Healthcare Provider Details

I. General information

NPI: 1457520819
Provider Name (Legal Business Name): PATRICIA LANE RN PHD SNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SIMON ST
METAIRIE LA
70003-6427
US

IV. Provider business mailing address

8101 SIMON ST
METAIRIE LA
70003-6427
US

V. Phone/Fax

Practice location:
  • Phone: 504-737-5523
  • Fax: 504-737-2649
Mailing address:
  • Phone: 504-737-5523
  • Fax: 504-737-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number041019
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: