Provider Demographics
NPI:1437875325
Name:LANE, CRYSTAL M (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4057 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9710
Mailing Address - Country:US
Mailing Address - Phone:315-719-1704
Mailing Address - Fax:
Practice Address - Street 1:1991 BALSLEY RD
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-6725
Practice Address - Country:US
Practice Address - Phone:315-539-9229
Practice Address - Fax:315-539-0940
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310962363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health