Provider Demographics
NPI:1366731390
Name:MAGNUSSON, LANE MARIE (RN PHN)
Entity type:Individual
Prefix:MRS
First Name:LANE
Middle Name:MARIE
Last Name:MAGNUSSON
Suffix:
Gender:F
Credentials:RN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1338
Mailing Address - Country:US
Mailing Address - Phone:218-998-8379
Mailing Address - Fax:218-998-8352
Practice Address - Street 1:560 W FIR AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1364
Practice Address - Country:US
Practice Address - Phone:218-998-8379
Practice Address - Fax:218-998-8352
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 101445-1251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare