Provider Demographics
NPI:1154868982
Name:LANE, CHARLOTTE (FNP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 OLD LEETOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-5573
Mailing Address - Country:US
Mailing Address - Phone:522-259-6283
Mailing Address - Fax:
Practice Address - Street 1:46200 POTOMAC RUN PLZ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6622
Practice Address - Country:US
Practice Address - Phone:571-313-5087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009242363LF0000X
NC253667163W00000X
WV108980163W00000X, 363LF0000X
VA0024183698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse