Provider Demographics
NPI:1992848048
Name:LANE, NICOLE LOUISE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LOUISE
Last Name:LANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 FARRINGTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8169
Mailing Address - Country:US
Mailing Address - Phone:984-974-5700
Mailing Address - Fax:984-974-7470
Practice Address - Street 1:6011 FARRINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8169
Practice Address - Country:US
Practice Address - Phone:984-974-5700
Practice Address - Fax:984-974-7470
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03065363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant