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NPI Code Detail

MEDICARE: DENAE LESLIE LANE NP

MEDICARE: DENAE LESLIE LANE NP
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 Practitioner20211SC

General Provider Information

NPI Number : 1366960429
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENAE LESLIE LANE NP
Provider Business Mailing Address
First Line : 1 INDEPENDENCE PT STE 212
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-4536
Country : US
Telephone Number : 864-455-3287
Fax Number : 864-455-5723
Provider Business Practice Location Address
First Line : 16 HYLAND RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-5756
Country : US
Telephone Number : 864-627-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2017
Last Update Date : 03/02/2021

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Directions to “ DENAE LESLIE LANE NP” Practice Location

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