Provider Demographics
NPI:1649993205
Name:LANE, JANET (LPN, ICP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:LPN, ICP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:AL
Mailing Address - Zip Code:36250-5358
Mailing Address - Country:US
Mailing Address - Phone:256-613-8456
Mailing Address - Fax:
Practice Address - Street 1:1945 DAVIS DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-3276
Practice Address - Country:US
Practice Address - Phone:256-547-4938
Practice Address - Fax:256-547-0773
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-062826164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse