Provider Demographics
NPI:1619533791
Name:LANE, GREG (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MCKELVEY AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1239
Mailing Address - Country:US
Mailing Address - Phone:661-829-7477
Mailing Address - Fax:
Practice Address - Street 1:6001 TRUXTUN AVE STE 120
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0675
Practice Address - Country:US
Practice Address - Phone:661-489-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN469260163WE0003X
CANP95018834363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency