Provider Demographics
NPI:1750684577
Name:LANE, CYNTHIA (RN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 E 1ST ST STE 137
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2804
Mailing Address - Country:US
Mailing Address - Phone:719-539-4510
Mailing Address - Fax:719-539-7197
Practice Address - Street 1:448 E 1ST ST STE 137
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2804
Practice Address - Country:US
Practice Address - Phone:719-539-4510
Practice Address - Fax:719-539-7197
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO181730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse