=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386435584
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHAEL KAREN LANE-SUGG FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2025
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3775 HOMESTEAD DR
-----------------------------------------------------
City | MEAD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80542-4516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-217-1378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3775 HOMESTEAD DR
-----------------------------------------------------
City | MEAD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80542-4516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-217-1378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APN.1000656-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------