Provider Demographics
NPI:1801923727
Name:LANE, ANGELA S (CRNA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:LANE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 PAIR RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-5662
Mailing Address - Country:US
Mailing Address - Phone:731-588-0001
Mailing Address - Fax:731-587-2775
Practice Address - Street 1:161 MOUNT PELIA RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3811
Practice Address - Country:US
Practice Address - Phone:731-588-0001
Practice Address - Fax:731-587-2775
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 12520367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered