Provider Demographics
NPI:1164045506
Name:LANE, NICHOLAS HULSHOF (NP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:HULSHOF
Last Name:LANE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 COUNTRY DR APT 153
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6460
Mailing Address - Country:US
Mailing Address - Phone:615-495-4197
Mailing Address - Fax:
Practice Address - Street 1:1124 NEW HIGHWAY 52 E
Practice Address - Street 2:
Practice Address - City:WESTMORELAND
Practice Address - State:TN
Practice Address - Zip Code:37186-5032
Practice Address - Country:US
Practice Address - Phone:615-644-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily