Provider Demographics
NPI:1790383081
Name:LANE, LYLE EUGENE
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:EUGENE
Last Name:LANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 LANE HL
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26447-1405
Mailing Address - Country:US
Mailing Address - Phone:304-517-5742
Mailing Address - Fax:
Practice Address - Street 1:97 LANE HL
Practice Address - Street 2:
Practice Address - City:WALKERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26447-1405
Practice Address - Country:US
Practice Address - Phone:304-517-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant