MEDICARE: MICHELE LANE APRN

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	363LF0000X	Family Nurse Practitioner	210030	OK

General Provider Information

NPI Number	:	1912626771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE LANE APRN

Provider Business Mailing Address
First Line	:	1624 S POST RD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 S POST RD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6602
Country	:	US
Telephone Number	:	405-795-0602
Fax Number	:

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

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	08/24/2022

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Directions to “ MICHELE LANE APRN” Practice Location

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