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NPI Code Detail

MEDICARE: ALEXIS KRISTINA LANE MSW

MEDICARE: ALEXIS KRISTINA LANE MSW
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1699331579
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS KRISTINA LANE MSW
Provider Business Mailing Address
First Line : 8365 BELLA FAMIGLIA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89178-8250
Country : US
Telephone Number : 702-659-2373
Fax Number :
Provider Business Practice Location Address
First Line : 6402 MCLEOD DR STE 5
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-4406
Country : US
Telephone Number : 702-898-5311
Fax Number : 702-222-3275
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2019
Last Update Date : 05/18/2019

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