Provider Demographics
NPI:1174390660
Name:LANE, JONATHAN CHRISTOPHER (PA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHRISTOPHER
Last Name:LANE
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:683 WAIANAE AVE
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96786
Mailing Address - Country:US
Mailing Address - Phone:808-683-2778
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:909-273-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2024-04-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant