Provider Demographics
NPI:1336334192
Name:LANE, SARAH MARIE (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:LANE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:13909 W WAINWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1969
Mailing Address - Country:US
Mailing Address - Phone:208-389-2213
Mailing Address - Fax:208-389-4659
Practice Address - Street 1:14500 99TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4730
Practice Address - Country:US
Practice Address - Phone:763-898-1000
Practice Address - Fax:763-898-1009
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2022-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-1030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant