=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558224006
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY NICHOLE LENANE FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14300 GALLANT FOX LN STE 106
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20715-4031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-383-0481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3161 OLD FORGE HILL RD
-----------------------------------------------------
City | STREET
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21154-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-504-4850
-----------------------------------------------------
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 | R253591
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------