Provider Demographics
NPI:1982219481
Name:LANE, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 FORSYTHIA DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1608
Mailing Address - Country:US
Mailing Address - Phone:513-752-2729
Mailing Address - Fax:
Practice Address - Street 1:4208 FORSYTHIA DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1608
Practice Address - Country:US
Practice Address - Phone:513-752-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health