Healthcare Provider Details

I. General information

NPI: 1912280108
Provider Name (Legal Business Name): LANE ERICKSON RN, ACNS-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W 15TH ST SUITE 290
PLANO TX
75093-5841
US

IV. Provider business mailing address

6400 LAKESHORE DR
DALLAS TX
75214-3737
US

V. Phone/Fax

Practice location:
  • Phone: 469-443-0925
  • Fax: 469-443-0933
Mailing address:
  • Phone: 512-529-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number775751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: