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General NPI Number Information
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NPI Number | 1568116267
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Entity Type | Individual
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Provider Name | NICOLE LANE
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Gender | Female
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 14700 WOODSON PARK DR APT 313
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City | HOUSTON
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State | TX
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Zip | 77044-4494
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Country | US
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Telephone | 832-352-1193
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Fax |
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Provider Business Mailing Address
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Address Line | 14700 WOODSON PARK DR APT 313
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City | HOUSTON
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State | TX
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Zip | 77044-4494
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Country | US
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Telephone |
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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