Healthcare Provider Details

I. General information

NPI: 1235862038
Provider Name (Legal Business Name): LANEA GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 CAMERON RD
BALTIMORE MD
21212-4002
US

IV. Provider business mailing address

7 GREENSHIRE LN
OWINGS MILLS MD
21117-4813
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-5853
  • Fax:
Mailing address:
  • Phone: 410-908-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP52924
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: