Provider Demographics
NPI:1578884920
Name:LANE, KATHLEEN M (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S LODER AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4810
Mailing Address - Country:US
Mailing Address - Phone:607-727-2168
Mailing Address - Fax:607-757-2853
Practice Address - Street 1:101 S LODER AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4810
Practice Address - Country:US
Practice Address - Phone:607-727-2168
Practice Address - Fax:607-757-2853
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390067-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool