Healthcare Provider Details

I. General information

NPI: 1295130839
Provider Name (Legal Business Name): MARY ELIZABETH LANE WHNP-BC, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH YARBRO

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350A CLEVELAND ST
GREENVILLE SC
29607-2408
US

IV. Provider business mailing address

1181 FIRST COLONIAL RD STE 200
VIRGINIA BEACH VA
23454-2437
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-1600
  • Fax:
Mailing address:
  • Phone: 757-425-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number19119
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024173336
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: