MEDICARE: NICOLE LANE-LEHEW MS, LAT, ATC

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	2255A2300X	Athletic Trainer	ATR-009057	AZ

General Provider Information

NPI Number	:	1376008128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LANE-LEHEW MS, LAT, ATC

Provider Business Mailing Address
First Line	:	37100 N GANTZEL RD STE 107
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85140-7350
Country	:	US
Telephone Number	:	480-394-4480
Fax Number	:	602-805-2828

Provider Business Practice Location Address
First Line	:	37100 N GANTZEL RD STE 107
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85140-7350
Country	:	US
Telephone Number	:	480-394-4480
Fax Number	:	602-805-2828

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

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	03/06/2023

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