Provider Demographics
NPI:1952173890
Name:LANE, BOBBI
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DRAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58736-4102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 MAIN ST
Practice Address - Street 2:
Practice Address - City:DRAKE
Practice Address - State:ND
Practice Address - Zip Code:58736-4102
Practice Address - Country:US
Practice Address - Phone:701-720-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant