Provider Demographics
NPI:1639310253
Name:LANE, FELICIA RENEE (RD)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:RENEE
Last Name:LANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5840
Mailing Address - Country:US
Mailing Address - Phone:520-694-6692
Mailing Address - Fax:520-694-6276
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:ROOM 0430
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-694-6692
Practice Address - Fax:520-694-6276
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered