Provider Demographics
NPI:1831945641
Name:LANE, TASHA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13611 S US ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-7766
Mailing Address - Country:US
Mailing Address - Phone:765-461-0062
Mailing Address - Fax:
Practice Address - Street 1:14801 MARKET CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-5518
Practice Address - Country:US
Practice Address - Phone:765-461-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003849A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered