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General NPI Number Information
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NPI Number | 1104220011
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Entity Type | Individual
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Provider Name | NINA C. LANE NP
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Gender | Female
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 224 E MAIN ST STE 119
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City | ELKTON
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State | MD
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Zip | 21921-5790
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Country | US
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Telephone | 866-472-6288
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Fax |
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Provider Business Mailing Address
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Address Line | 224 E MAIN ST STE 119
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City | ELKTON
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State | MD
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Zip | 21921-5790
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Country | US
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Telephone | 866-472-6288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 26NJ005255800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00525800
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License Number State | NJ
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