Provider Demographics
NPI:1205044310
Name:LANE, OLLIE MAUDE
Entity Type:Individual
Prefix:MS
First Name:OLLIE
Middle Name:MAUDE
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 S TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3247
Mailing Address - Country:US
Mailing Address - Phone:614-279-8525
Mailing Address - Fax:
Practice Address - Street 1:171 S TERRACE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3247
Practice Address - Country:US
Practice Address - Phone:614-279-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide