Provider Demographics
NPI:1457852709
Name:LANE, JALEN WESLEY
Entity Type:Individual
Prefix:
First Name:JALEN
Middle Name:WESLEY
Last Name:LANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 VZ CR 3812
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169
Mailing Address - Country:US
Mailing Address - Phone:214-676-0414
Mailing Address - Fax:214-676-0414
Practice Address - Street 1:1455 VZ CR 3812
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169
Practice Address - Country:US
Practice Address - Phone:214-676-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant