Provider Demographics
NPI:1902815756
Name:DUKE, DAVID LANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LANE
Last Name:DUKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N WEBB RD
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1751
Mailing Address - Country:US
Mailing Address - Phone:308-227-1514
Mailing Address - Fax:
Practice Address - Street 1:2121 N WEBB RD
Practice Address - Street 2:SUITE 103A
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1751
Practice Address - Country:US
Practice Address - Phone:308-227-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE628103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q61206Medicare UPIN
279667Medicare ID - Type Unspecified