Provider Demographics
NPI:1285710277
Name:LANE, CARRIE L (FNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:LANE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2807
Mailing Address - Country:US
Mailing Address - Phone:541-962-3524
Mailing Address - Fax:541-962-3825
Practice Address - Street 1:1 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2807
Practice Address - Country:US
Practice Address - Phone:541-962-3524
Practice Address - Fax:541-962-3825
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250079NP FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR058518019OtherREGENCE BLUE CROSS BS
OR237220Medicaid
OR237220Medicaid
OR114374Medicare ID - Type Unspecified