Provider Demographics
NPI:1972756450
Name:LANE, CYNTHIA JEAN (NP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:LANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:JEAN
Other - Last Name:HOPSICKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 WHITE BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12842-1424
Mailing Address - Country:US
Mailing Address - Phone:518-648-5355
Mailing Address - Fax:518-648-6437
Practice Address - Street 1:143 WHITE BIRCH LN
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842-1424
Practice Address - Country:US
Practice Address - Phone:518-648-5355
Practice Address - Fax:518-648-6437
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400384363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health