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NPI Code Detail

MEDICARE: MICHELLE L LANE

MEDICARE: MICHELLE L LANE
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 Practitioner32016SC
2363L00000XNurse Practitioner344578NY

General Provider Information

NPI Number : 1639730690
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE L LANE
Provider Business Mailing Address
First Line : 301 PROSPECT AVE FL 6
Second Line :
City : SYRACUSE
State : NY
Zip : 13203-1807
Country : US
Telephone Number : 315-448-5491
Fax Number : 315-423-6823
Provider Business Practice Location Address
First Line : 301 PROSPECT AVE FL 6
Second Line :
City : SYRACUSE
State : NY
Zip : 13203-1807
Country : US
Telephone Number : 315-448-5491
Fax Number : 315-423-6823
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2019
Last Update Date : 06/04/2026

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Directions to “ MICHELLE L LANE ” Practice Location

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