Provider Demographics
NPI:1346786704
Name:HIEDI LANE ARNP, PLLC
Entity Type:Organization
Organization Name:HIEDI LANE ARNP, PLLC
Other - Org Name:HIEDI LANE ARNP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HIEDI
Authorized Official - Middle Name:C
Authorized Official - Last Name:STJARNA LANE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:319-321-0798
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-0002
Mailing Address - Country:US
Mailing Address - Phone:319-321-0798
Mailing Address - Fax:
Practice Address - Street 1:1101 E HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3035
Practice Address - Country:US
Practice Address - Phone:319-321-0798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG-107550363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty