Provider Demographics
NPI:1831219112
Name:LANE, JEANNIE MARIE (CNA)
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:MARIE
Last Name:LANE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 ALLEN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:PARROTTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37843-2711
Mailing Address - Country:US
Mailing Address - Phone:423-613-0610
Mailing Address - Fax:
Practice Address - Street 1:430 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3752
Practice Address - Country:US
Practice Address - Phone:423-623-8733
Practice Address - Fax:423-623-0874
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide