=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033575956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANE FERTILITY INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2016
-----------------------------------------------------
Last Update Date | 01/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 ROWLAND WAY STE 305
-----------------------------------------------------
City | NOVATO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94945-5056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-893-0391
-----------------------------------------------------
Fax | 415-892-4455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 ROWLAND WAY STE 305
-----------------------------------------------------
City | NOVATO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94945-5056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-893-0391
-----------------------------------------------------
Fax | 415-892-4455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIELLE ELIZABETH LANE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 415-893-0391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------