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General NPI Number Information
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NPI Number | 1265760235
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Entity Type | Organization
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Legal Business Name | LANE WOMEN'S HEALTH GROUP PC
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Dates
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Enumeration Date | 12/02/2009
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 400 FOOTE AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701
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Country | US
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Telephone | 716-484-9194
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Fax | 716-484-0115
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Provider Business Mailing Address
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Address Line | 400 FOOTE AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701-6800
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Country | US
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Telephone | 716-484-9194
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Fax | 716-484-9148
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. COLLETTE K KEITH
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Credential |
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Telephone | 716-484-9194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 199070
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License Number State | NY
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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 | F334150
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | MW417569
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 364SW0102X
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Taxonomy Name | Women's Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 131973
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License Number State | NY
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