Provider Demographics
NPI:1669687034
Name:LANE, DANIELLE DAWN
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:DAWN
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11687 LONDON ROAD
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146
Mailing Address - Country:US
Mailing Address - Phone:614-353-9783
Mailing Address - Fax:
Practice Address - Street 1:11687 LONDON ROAD
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146
Practice Address - Country:US
Practice Address - Phone:614-353-9783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2663738Medicaid