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NPI Code Detail

MEDICARE: MS. BETTY SUSAN LANE PHD, MSN, BSN, FNP

MEDICARE: MS. BETTY SUSAN LANE PHD, MSN, BSN, FNP
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
1363LF0000XFamily Nurse PractitionerRN136886GA

General Provider Information

NPI Number : 1336663632
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BETTY SUSAN LANE PHD, MSN, BSN, FNP
Provider Business Mailing Address
First Line : 815 SMOKEY WAY
Second Line :
City : PEACHTREE CITY
State : GA
Zip : 30269-3383
Country : US
Telephone Number : 770-891-2689
Fax Number :
Provider Business Practice Location Address
First Line : 101 LEXINGTON CIR
Second Line :
City : PEACHTREE CITY
State : GA
Zip : 30269-6845
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-652-9787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2017
Last Update Date : 07/28/2017

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