Provider Demographics
NPI:1063239358
Name:LANE, SYDNEY M
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:M
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 1:315 ELTON HILLS DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2988
Mailing Address - Country:US
Mailing Address - Phone:651-399-2439
Mailing Address - Fax:507-322-6566
Practice Address - Street 1:315 ELTON HILLS DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2988
Practice Address - Country:US
Practice Address - Phone:651-399-2439
Practice Address - Fax:507-322-6566
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12119363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health