Provider Demographics
NPI:1336663632
Name:LANE, BETTY SUSAN (PHD, MSN, BSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:SUSAN
Last Name:LANE
Suffix:
Gender:F
Credentials:PHD, MSN, BSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SMOKEY WAY
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3383
Mailing Address - Country:US
Mailing Address - Phone:770-891-2689
Mailing Address - Fax:
Practice Address - Street 1:101 LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6845
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN136886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily