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General NPI Number Information
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NPI Number | 1245738210
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Entity Type | Individual
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Provider Name | KIMBERLY ANN LANE
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Gender | Female
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 1 CHILDRENS PLZ
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City | DAYTON
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State | OH
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Zip | 45404-1873
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Country | US
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Telephone | 513-484-8047
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Fax |
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Provider Business Mailing Address
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Address Line | 7033 HEARTHSIDE CT
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City | LIBERTY TWP
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State | OH
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Zip | 45011-6593
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Country | US
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Telephone | 513-484-8047
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN.CNP.021536
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License Number State | OH
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