Provider Demographics
NPI:1700993334
Name:LANE, MELIEA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:MELIEA
Middle Name:ANN
Last Name:LANE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 PROFESSIONAL DR STE #405
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-769-7500
Mailing Address - Fax:707-769-7570
Practice Address - Street 1:1456 PROFESSIONAL DR STE #405
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-769-7500
Practice Address - Fax:707-769-7570
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA268070OtherREGISTERED NURSE LICENSE