Provider Demographics
NPI:1285973545
Name:LANE, ROSELYN MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:ROSELYN
Middle Name:MARIE
Last Name:LANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 NE 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6744
Mailing Address - Country:US
Mailing Address - Phone:206-252-4817
Mailing Address - Fax:206-252-4811
Practice Address - Street 1:1410 NE 66TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6744
Practice Address - Country:US
Practice Address - Phone:206-252-4817
Practice Address - Fax:206-252-4811
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00053208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse