Provider Demographics
NPI:1760845093
Name:LANE, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:GANS
Mailing Address - State:OK
Mailing Address - Zip Code:74936-0070
Mailing Address - Country:US
Mailing Address - Phone:918-775-2236
Mailing Address - Fax:
Practice Address - Street 1:204 N STACY AVE
Practice Address - Street 2:
Practice Address - City:GANS
Practice Address - State:OK
Practice Address - Zip Code:74936-0070
Practice Address - Country:US
Practice Address - Phone:918-775-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider