Provider Demographics
NPI:1851455943
Name:LANE, ROBERTA S (PNP-C)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:S
Last Name:LANE
Suffix:
Gender:F
Credentials:PNP-C
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP-C
Mailing Address - Street 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-272-9447
Mailing Address - Fax:
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-272-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29697363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC300046OtherNC BON PRESCRIBING NUMBER
NC78259OtherPED NURSING CERTIFICATION