Provider Demographics
NPI:1720410400
Name:LANE, COURTNEY ANNE (CNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANNE
Last Name:LANE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANNE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-486-5993
Mailing Address - Fax:616-486-6345
Practice Address - Street 1:145 MICHIGAN ST NE
Practice Address - Street 2:SUITE 4100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-486-5993
Practice Address - Fax:616-486-6345
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300862363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology