Provider Demographics
NPI:1760245716
Name:LANE, PATRICIA BRIDGET (RDN, LD/N, LD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:BRIDGET
Last Name:LANE
Suffix:
Gender:F
Credentials:RDN, LD/N, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 NE SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4846
Mailing Address - Country:US
Mailing Address - Phone:954-592-2502
Mailing Address - Fax:
Practice Address - Street 1:110 MEMORIAL HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4940
Practice Address - Country:US
Practice Address - Phone:936-228-1689
Practice Address - Fax:224-257-7474
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-2023-048133V00000X
FLND10141133V00000X
86015440133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered