Healthcare Provider Details

I. General information

NPI: 1073907770
Provider Name (Legal Business Name): JANUARY LANE MSN, NNP, RNC-LRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 05/15/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE DEPT OF PEDIATRICS-NEONATOLOGY BOX 651
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

771 ELMWOOD TER
ROCHESTER NY
14620-3715
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2972
  • Fax:
Mailing address:
  • Phone: 757-589-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number350380
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number35 350380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: