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NPI Code Detail

MEDICARE: CANDICE LANE

MEDICARE:   CANDICE  LANE
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
1163W00000XRegistered Nurse412702OH

General Provider Information

NPI Number : 1265117063
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDICE LANE
Provider Business Mailing Address
First Line : 1468 W 9TH ST STE 100
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-1252
Country : US
Telephone Number : 440-665-4176
Fax Number :
Provider Business Practice Location Address
First Line : 1468 W 9TH ST STE 100
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-1252
Country : US
Telephone Number : 440-665-4176
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2023
Last Update Date : 06/19/2023

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Directions to “ CANDICE LANE ” Practice Location

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