Provider Demographics
NPI:1821419094
Name:SALAZAR, LANE RICHARD (DNP, APN)
Entity Type:Individual
Prefix:MR
First Name:LANE
Middle Name:RICHARD
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:DNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3454
Mailing Address - Country:US
Mailing Address - Phone:479-414-4467
Mailing Address - Fax:
Practice Address - Street 1:302 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3454
Practice Address - Country:US
Practice Address - Phone:479-414-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR74308163W00000X
ARA004003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse