Provider Demographics
NPI:1548583065
Name:LANE, MOLLY E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:E
Last Name:LANE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FRANK ST.
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103
Mailing Address - Country:US
Mailing Address - Phone:585-415-9052
Mailing Address - Fax:
Practice Address - Street 1:114 FRANK ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1715
Practice Address - Country:US
Practice Address - Phone:585-415-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195257164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse