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General NPI Number Information
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NPI Number | 1427571017
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Entity Type | Individual
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Provider Name | STEPHANIE J LANE
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Gender | Female
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 524 SIGNAL HILL DRIVE EXT
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City | STATESVILLE
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State | NC
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Zip | 28625-4391
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Country | US
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Telephone | 704-871-1045
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Fax | 704-873-6647
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Provider Business Mailing Address
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Address Line | 284 EXECUTIVE PARK DR STE 100
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City | CONCORD
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State | NC
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Zip | 28025-1833
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Country | US
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Telephone | 704-939-1100
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Fax | 704-939-1173
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5009765
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5009765
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5009765
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License Number State | NC
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