Healthcare Provider Details

I. General information

NPI: 1851210173
Provider Name (Legal Business Name): KIMBERLY GRACE LANE CPM, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N BOUNDARY ST
WILLIAMSBURG VA
23185-3610
US

IV. Provider business mailing address

8417 ROLFE HWY
DENDRON VA
23839-2108
US

V. Phone/Fax

Practice location:
  • Phone: 757-696-7175
  • Fax:
Mailing address:
  • Phone: 757-758-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: