Provider Demographics
NPI:1710335039
Name:LANE, NATALIE ANNE (LD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:LANE
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 7TH ST
Mailing Address - Street 2:310
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-5809
Mailing Address - Country:US
Mailing Address - Phone:702-416-7607
Mailing Address - Fax:
Practice Address - Street 1:8826 S EASTERN AVE
Practice Address - Street 2:111
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4824
Practice Address - Country:US
Practice Address - Phone:702-478-5080
Practice Address - Fax:702-297-6586
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist