Provider Demographics
NPI:1447406319
Name:LANE, MARCELLA MARIE
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:MARIE
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:PO BOX 3126
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-0126
Mailing Address - Country:US
Mailing Address - Phone:313-465-5173
Mailing Address - Fax:313-429-3550
Practice Address - Street 1:17625 REED ST
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1142
Practice Address - Country:US
Practice Address - Phone:313-282-9151
Practice Address - Fax:313-429-3550
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle