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NPI Code Detail

MEDICARE: LANE DUDO FNP-C

MEDICARE: LANE DUDO FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAP139752TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1930848OTHERTXMEDICARE
2P02416489OTHERTXMEDICARE RAIL ROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
48LY464OTHERTXBCBS

General Provider Information

NPI Number : 1164994430
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANE DUDO FNP-C
Provider Business Mailing Address
First Line : 910 E HOUSTON ST STE 100
Second Line :
City : TYLER
State : TX
Zip : 75702-8363
Country : US
Telephone Number : 903-606-8718
Fax Number : 903-606-1218
Provider Business Practice Location Address
First Line : 910 E HOUSTON ST STE 100
Second Line :
City : TYLER
State : TX
Zip : 75702-8363
Country : US
Telephone Number : 903-606-8718
Fax Number : 903-606-1218
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2018
Last Update Date : 11/13/2025

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Directions to “ LANE DUDO FNP-C” Practice Location

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