Provider Demographics
NPI:1316514052
Name:LANE, AUDREY ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ROSE
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:986270 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-6270
Mailing Address - Country:US
Mailing Address - Phone:402-559-7792
Mailing Address - Fax:402-559-9385
Practice Address - Street 1:986270 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-6270
Practice Address - Country:US
Practice Address - Phone:402-559-7792
Practice Address - Fax:402-559-9385
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9007390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program