Provider Demographics
NPI:1386327377
Name:LANE, CARRIE ASHLYNN
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ASHLYNN
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62895 HAMBY RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9575
Mailing Address - Country:US
Mailing Address - Phone:541-389-1409
Mailing Address - Fax:
Practice Address - Street 1:62895 HAMBY RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9575
Practice Address - Country:US
Practice Address - Phone:541-389-1409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator