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General NPI Number Information
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NPI Number | 1457932337
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Entity Type | Individual
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Provider Name | MICHAEL JENNINGS LANE SR. DNP PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 10110 DONALD S POWERS DR STE 101C
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City | MUNSTER
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State | IN
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Zip | 46321-4070
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Country | US
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Telephone | 269-250-8013
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Fax | 877-326-2856
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Provider Business Mailing Address
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Address Line | 10110 DONALD S POWERS DR STE 101C
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City | MUNSTER
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State | IN
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Zip | 46321-4070
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Country | US
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Telephone | 269-250-8013
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 041354134
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 28230854A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209023083
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71011081A
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License Number State | IN
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