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NPI Code Detail

MEDICARE: DUSTIN ALEX LANE

MEDICARE: DUSTIN ALEX 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
1163W00000XRegistered Nurse59114ID
2367500000XCertified Registered Nurse Anesthetist9071278ID

General Provider Information

NPI Number : 1730983388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DUSTIN ALEX LANE
Provider Business Mailing Address
First Line : 262 W WAUSAU ST
Second Line :
City : MERIDIAN
State : ID
Zip : 83646-6938
Country : US
Telephone Number : 541-620-0935
Fax Number :
Provider Business Practice Location Address
First Line : 190 E BANNOCK ST
Second Line :
City : BOISE
State : ID
Zip : 83712-6241
Country : US
Telephone Number : 208-381-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2025
Last Update Date : 08/20/2025

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Directions to “ DUSTIN ALEX LANE ” Practice Location

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