Provider Demographics
NPI:1376725440
Name:LANE, DELLA J
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:J
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 N UPPER GOLD RD
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-7392
Mailing Address - Country:US
Mailing Address - Phone:928-308-0383
Mailing Address - Fax:
Practice Address - Street 1:1140 N UPPER GOLD RD
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-7392
Practice Address - Country:US
Practice Address - Phone:928-308-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist