Provider Demographics
NPI:1083598494
Name:LANE, TIA MICHELLE
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:MICHELLE
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 1:1938 BUFFINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1538
Mailing Address - Country:US
Mailing Address - Phone:304-563-5559
Mailing Address - Fax:
Practice Address - Street 1:1938 BUFFINGTON AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1538
Practice Address - Country:US
Practice Address - Phone:304-563-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant