Provider Demographics
NPI:1396707576
Name:SMITH-LANE, PAULA (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:SMITH-LANE
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9702
Mailing Address - Country:US
Mailing Address - Phone:507-265-6300
Mailing Address - Fax:570-268-2807
Practice Address - Street 1:8805 SR 6
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MESHOPPEN
Practice Address - State:PA
Practice Address - Zip Code:18630-8149
Practice Address - Country:US
Practice Address - Phone:570-265-6300
Practice Address - Fax:570-268-2807
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP0004355B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily