Provider Demographics
NPI:1275081531
Name:LANE, AGNES E
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:E
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:ONWUANUMKPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 MORRIS AVE
Mailing Address - Street 2:APT 1-C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-5946
Mailing Address - Country:US
Mailing Address - Phone:914-932-6402
Mailing Address - Fax:
Practice Address - Street 1:1910 MORRIS AVE
Practice Address - Street 2:APT 1-C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5946
Practice Address - Country:US
Practice Address - Phone:914-932-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249649164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse