Provider Demographics
NPI:1891004073
Name:LANE, DEBORAH HILTON (LPN)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:HILTON
Last Name:LANE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:HILTON
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:169 LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2347
Mailing Address - Country:US
Mailing Address - Phone:315-466-3737
Mailing Address - Fax:
Practice Address - Street 1:169 LOMA AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2347
Practice Address - Country:US
Practice Address - Phone:315-466-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111527-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02647794Medicaid