MEDICARE: MR. JEFFREY L LANE APN

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	363LA2200X	Adult Health Nurse Practitioner	28160209A	IN

General Provider Information

NPI Number	:	1851537690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY L LANE APN

Provider Business Mailing Address
First Line	:	207 HAMILTON ST
Second Line	:
City	:	CRAWFORDSVILLE
State	:	IN
Zip	:	47933-1916
Country	:	US
Telephone Number	:	765-361-8959
Fax Number	:

Provider Business Practice Location Address
First Line	:	9511 ANGOLA CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1119
Country	:	US
Telephone Number	:	317-874-0702
Fax Number	:

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

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	05/06/2013

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