Provider Demographics
NPI:1265779995
Name:LANE, CASSIE S (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:S
Last Name:LANE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:MATTES
Other - Last Name:SKLUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5805 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5427
Mailing Address - Country:US
Mailing Address - Phone:804-913-2262
Mailing Address - Fax:
Practice Address - Street 1:5805 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-5427
Practice Address - Country:US
Practice Address - Phone:804-913-2262
Practice Address - Fax:804-282-9921
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001222095367500000X
VA0024170620367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered