MEDICARE: KATHERINE MARIE LANEY RN

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
1	163WG0000X	General Practice Registered Nurse	R198436-1	MN

General Provider Information

NPI Number	:	1306329933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MARIE LANEY RN

Provider Business Mailing Address
First Line	:	921 WOODLAND DR
Second Line	:
City	:	MOOSE LAKE
State	:	MN
Zip	:	55767-9408
Country	:	US
Telephone Number	:	218-428-4746
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 ARROWHEAD LN
Second Line	:
City	:	MOOSE LAKE
State	:	MN
Zip	:	55767-9453
Country	:	US
Telephone Number	:	218-485-4401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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