Healthcare Provider Details

I. General information

NPI: 1366325672
Provider Name (Legal Business Name): JEFF LANE MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 PROFESSIONAL CIR
RENO NV
89521-4802
US

IV. Provider business mailing address

10315 PROFESSIONAL CIR
RENO NV
89521-4802
US

V. Phone/Fax

Practice location:
  • Phone: 775-515-5308
  • Fax: 775-515-5308
Mailing address:
  • Phone: 775-515-5308
  • Fax: 775-515-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN293239
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: