Provider Demographics
NPI:1780643445
Name:LANE, SHAINA MARIE (MED, ATC)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:MARIE
Last Name:LANE
Suffix:
Gender:F
Credentials:MED, ATC
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Other - First Name:
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Mailing Address - Street 1:3707 CRYSTAL ST SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1368
Mailing Address - Country:US
Mailing Address - Phone:616-498-4709
Mailing Address - Fax:
Practice Address - Street 1:GRAND VALLEY STATE UNIVERSITY
Practice Address - Street 2:1 CAMPUS DR., 83 FH
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401
Practice Address - Country:US
Practice Address - Phone:616-331-3140
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer