Provider Demographics
NPI:1982825824
Name:LANE, KIERA (NMD)
Entity Type:Individual
Prefix:DR
First Name:KIERA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 W RAY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3558
Mailing Address - Country:US
Mailing Address - Phone:480-722-2811
Mailing Address - Fax:480-722-2817
Practice Address - Street 1:2480 W. RAY ROAD, SUITE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-722-2811
Practice Address - Fax:480-722-2817
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 00-593175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath