Healthcare Provider Details

I. General information

NPI: 1245526342
Provider Name (Legal Business Name): JENNY L. LANE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ANTRIM RD CHFHC - HILLSBORO-DEERING
HILLSBORO NH
03244-5250
US

IV. Provider business mailing address

15 ANTRIM RD CHFHC - HILLSBORO-DEERING
HILLSBORO NH
03244-5250
US

V. Phone/Fax

Practice location:
  • Phone: 603-464-3434
  • Fax: 603-464-3440
Mailing address:
  • Phone: 603-464-3434
  • Fax: 603-464-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number050505-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: