Provider Demographics
NPI:1346977980
Name:LANE, FIONA (DNP)
Entity Type:Individual
Prefix:
First Name:FIONA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10431 PENTAGON DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1362
Mailing Address - Country:US
Mailing Address - Phone:708-623-4336
Mailing Address - Fax:
Practice Address - Street 1:2850 S WABASH AVE STE 106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2491
Practice Address - Country:US
Practice Address - Phone:312-842-4400
Practice Address - Fax:312-842-4595
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025415363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health