Provider Demographics
NPI:1639422678
Name:LANE, WENDY ANN (RN, CRNFA)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANN
Last Name:LANE
Suffix:
Gender:F
Credentials:RN, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1504
Mailing Address - Country:US
Mailing Address - Phone:218-340-3958
Mailing Address - Fax:
Practice Address - Street 1:2622 E 6TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1504
Practice Address - Country:US
Practice Address - Phone:218-340-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR133454-2163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant