Provider Demographics
NPI:1265988588
Name:LANE, MARIE
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:FLORENCE
Other - Last Name:EGALITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 OCEAN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-1849
Mailing Address - Country:US
Mailing Address - Phone:561-859-5051
Mailing Address - Fax:
Practice Address - Street 1:480 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-1849
Practice Address - Country:US
Practice Address - Phone:561-859-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5153244373H00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist