Provider Demographics
NPI:1164651170
Name:LANE, MATTHEW J (LPN/LVN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:LANE
Suffix:
Gender:M
Credentials:LPN/LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 REED RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:NH
Mailing Address - Zip Code:03048-4710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:331 REED RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:NH
Practice Address - Zip Code:03048-4710
Practice Address - Country:US
Practice Address - Phone:978-877-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB1538026146N00000X
TX209886164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic