Provider Demographics
NPI:1619548005
Name:LANE, MOLLY (LPN)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
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 1:4216 OLD MILL COVE TRL W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1582
Mailing Address - Country:US
Mailing Address - Phone:912-675-5193
Mailing Address - Fax:904-256-4646
Practice Address - Street 1:4216 OLD MILL COVE TRL W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1582
Practice Address - Country:US
Practice Address - Phone:912-675-5193
Practice Address - Fax:904-256-4646
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant