Provider Demographics
NPI:1629237284
Name:LANE, MARY P (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:LANE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:STONY BROOK UNIV MED ICAL CTR
Mailing Address - Street 2:T12, 080 HEALTH SCIENCE CENTER
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-1210
Mailing Address - Fax:631-444-1535
Practice Address - Street 1:STONY BROOK UNIV MED ICAL CTR
Practice Address - Street 2:T12, 080 HEALTH SCIENCE CENTER
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1210
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
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Provider Licenses
StateLicense IDTaxonomies
NYF300770363LA2200X
NYF380761363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics