Provider Demographics
NPI:1225364144
Name:LANE, SUSAN ABDALLAH (CD LCCE, CLC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ABDALLAH
Last Name:LANE
Suffix:
Gender:F
Credentials:CD LCCE, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 45TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2929
Mailing Address - Country:US
Mailing Address - Phone:612-810-1544
Mailing Address - Fax:
Practice Address - Street 1:3644 45TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2929
Practice Address - Country:US
Practice Address - Phone:612-810-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula