MEDICARE: LUANNE G LANE ANP

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	363LP0200X	Pediatric Nurse Practitioner	041268666	IL

General Provider Information

NPI Number	:	1619111457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUANNE G LANE ANP

Provider Business Mailing Address
First Line	:	1701 W WISE RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-3553
Country	:	US
Telephone Number	:	847-895-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	27401 W HIGHWAY 22
Second Line	:	SUITE 103
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-5999
Country	:	US
Telephone Number	:	847-382-8900
Fax Number	:

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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