Provider Demographics
NPI:1942225149
Name:LANE, JENEAN M (PA-C)
Entity Type:Individual
Prefix:
First Name:JENEAN
Middle Name:M
Last Name:LANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:800 WALNUT STREET
Mailing Address - Street 2:19TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5109
Mailing Address - Country:US
Mailing Address - Phone:215-829-3409
Mailing Address - Fax:
Practice Address - Street 1:299 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4010
Practice Address - Country:US
Practice Address - Phone:215-829-3409
Practice Address - Fax:215-925-9749
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA050909363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097366Medicare PIN
PAS62741Medicare UPIN