Provider Demographics
NPI:1205464955
Name:LANE, RACHAEL NICOLE (DO)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NICOLE
Last Name:LANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:NICOLE
Other - Last Name:FOLKMIER-LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6401 PRAIRIE ST STE 2600
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7842
Mailing Address - Country:US
Mailing Address - Phone:231-672-7900
Mailing Address - Fax:231-672-7931
Practice Address - Street 1:6401 PRAIRIE ST STE 2600
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7842
Practice Address - Country:US
Practice Address - Phone:231-672-7900
Practice Address - Fax:231-672-7931
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine