MEDICARE: MRS. SHERRY JANE LANE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	3747P1801X	Personal Care Attendant	OH
2	3747P1801X	Personal Care Attendant
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578165304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRY JANE LANE

Provider Business Mailing Address
First Line	:	5626 FAIRLAND RD
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44216-9729
Country	:	US
Telephone Number	:	330-730-3786
Fax Number	:

Provider Business Practice Location Address
First Line	:	5626 FAIRLAND RD
Second Line	:
City	:	NEW FRANKLIN
State	:	OH
Zip	:	44216-9729
Country	:	US
Telephone Number	:	330-730-3786
Fax Number	:

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

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	01/04/2021

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Directions to “ MRS. SHERRY JANE LANE ” Practice Location

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