Provider Demographics
NPI:1063625135
Name:HARRIS-LANE, PANSY MAUREEN (NP)
Entity type:Individual
Prefix:
First Name:PANSY
Middle Name:MAUREEN
Last Name:HARRIS-LANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 E CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6446
Mailing Address - Country:US
Mailing Address - Phone:973-731-6253
Mailing Address - Fax:
Practice Address - Street 1:7512 E CLINTON ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6446
Practice Address - Country:US
Practice Address - Phone:973-731-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN34192207R00000X
NJ224102363LA2100X
AZ224102363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care