Provider Demographics
NPI:1336278415
Name:WHITE-KING, LANA R (MD)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:R
Last Name:WHITE-KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:R
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7516 MARINER DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2613
Mailing Address - Country:US
Mailing Address - Phone:612-810-0288
Mailing Address - Fax:
Practice Address - Street 1:7516 MARINER DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2613
Practice Address - Country:US
Practice Address - Phone:612-810-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine