MEDICARE: MONICA LANE LVN

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	164X00000X	Licensed Vocational Nurse	210319	TX

General Provider Information

NPI Number	:	1922563048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA LANE LVN

Provider Business Mailing Address
First Line	:	6216 CRESCENT ST
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-4749
Country	:	US
Telephone Number	:	817-223-9466
Fax Number	:

Provider Business Practice Location Address
First Line	:	6216 CRESCENT ST
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-4749
Country	:	US
Telephone Number	:	817-223-9466
Fax Number	:

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

Provider Enumeration Date	:	02/02/2019
Last Update Date	:	02/02/2019

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Directions to “ MONICA LANE LVN” Practice Location

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