Healthcare Provider Details

I. General information

NPI: 1457337693
Provider Name (Legal Business Name): ELIZABETH LANE OGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 LENDEW ST
GREENSBORO NC
27408-7007
US

IV. Provider business mailing address

1908 LENDEW ST
GREENSBORO NC
27408-7007
US

V. Phone/Fax

Practice location:
  • Phone: 336-273-2835
  • Fax: 336-273-1948
Mailing address:
  • Phone: 336-273-2835
  • Fax: 336-273-1948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number800039
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: