Provider Demographics
NPI:1578532032
Name:LANE, MARY E (CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:LANE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WILLSON
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3572
Mailing Address - Country:US
Mailing Address - Phone:406-587-0681
Mailing Address - Fax:406-587-9011
Practice Address - Street 1:300 N WILLSON
Practice Address - Street 2:SUITE 2001
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3572
Practice Address - Country:US
Practice Address - Phone:406-587-0681
Practice Address - Fax:406-587-9011
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN18707363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP74886OtherMEDICARE UPIN
MT0434538Medicaid