Provider Demographics
NPI:1639364276
Name:LANE, MARCIA LYNN (BCRN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:LYNN
Last Name:LANE
Suffix:
Gender:F
Credentials:BCRN, BSN
Other - Prefix:MS
Other - First Name:MARCIA
Other - Middle Name:LYNN
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:15436 BEL RED RD STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5536
Mailing Address - Country:US
Mailing Address - Phone:425-644-4100
Mailing Address - Fax:
Practice Address - Street 1:126 15TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3409
Practice Address - Country:US
Practice Address - Phone:253-445-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00120126163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse