Provider Demographics
NPI:1891415444
Name:LANESE, MARY (CPD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LANESE
Suffix:
Gender:F
Credentials:CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 COKER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2130
Mailing Address - Country:US
Mailing Address - Phone:937-601-2273
Mailing Address - Fax:
Practice Address - Street 1:3032 COKER DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-2130
Practice Address - Country:US
Practice Address - Phone:937-601-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula