Provider Demographics
NPI:1376008128
Name:LANE-LEHEW, NICOLE (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LANE-LEHEW
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BASCELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:37100 N GANTZEL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7350
Mailing Address - Country:US
Mailing Address - Phone:480-394-4480
Mailing Address - Fax:602-805-2828
Practice Address - Street 1:37100 N GANTZEL RD STE 107
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-7350
Practice Address - Country:US
Practice Address - Phone:480-394-4480
Practice Address - Fax:602-805-2828
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0090572255A2300X
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ827697381OtherUHC