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General NPI Number Information
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NPI Number | 1952666554
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Entity Type | Individual
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Provider Name | KORA LANE ADAM PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 248 MCHENRY ST
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City | BURLINGTON
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State | WI
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Zip | 53105-1828
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Country | US
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Telephone | 262-767-6990
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Fax |
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Provider Business Mailing Address
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Address Line | 31115 KETTER LN
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City | BURLINGTON
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State | WI
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Zip | 53105-9765
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2980-23
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-010018
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License Number State | IL
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