Provider Demographics
NPI:1033417266
Name:LANE, MONICA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:345 CYPRESS CREEK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4484
Mailing Address - Country:US
Mailing Address - Phone:512-336-2777
Mailing Address - Fax:512-336-2778
Practice Address - Street 1:345 CYPRESS CREEK RD STE 104
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-336-2777
Practice Address - Fax:512-336-2778
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136343363L00000X
MD180498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP136343OtherAPNP LICENSE