Provider Demographics
NPI:1124418843
Name:LANE, MADELINE SARANE (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:SARANE
Last Name:LANE
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 W 82ND PL
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2737
Mailing Address - Country:US
Mailing Address - Phone:913-406-7242
Mailing Address - Fax:
Practice Address - Street 1:2040 HUTTON RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4526
Practice Address - Country:US
Practice Address - Phone:913-299-3700
Practice Address - Fax:913-721-3316
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1124418843Medicaid