Provider Demographics
NPI:1659475911
Name:LANE, AMY MICHELLE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:LANE
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:19409 PLANTATION RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4493
Mailing Address - Country:US
Mailing Address - Phone:302-224-1400
Mailing Address - Fax:
Practice Address - Street 1:19409 PLANTATION RD, STE 4
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4413
Practice Address - Country:US
Practice Address - Phone:302-224-1400
Practice Address - Fax:302-224-1402
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010941363LP0808X
CT002158364SF0001X, 363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235942Medicaid
500000779Medicare ID - Type Unspecified
S76953Medicare UPIN
CTD400011232Medicare PIN