Healthcare Provider Details

I. General information

NPI: 1104220011
Provider Name (Legal Business Name): NINA C. LANE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E MAIN ST STE 119
ELKTON MD
21921-5790
US

IV. Provider business mailing address

224 E MAIN ST STE 119
ELKTON MD
21921-5790
US

V. Phone/Fax

Practice location:
  • Phone: 866-472-6288
  • Fax:
Mailing address:
  • Phone: 866-472-6288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00525800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ005255800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: