Provider Demographics
NPI:1427055870
Name:LANE, PATRICIA E (ACNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:LANE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2143
Mailing Address - Country:US
Mailing Address - Phone:903-597-2273
Mailing Address - Fax:903-597-2466
Practice Address - Street 1:825 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2143
Practice Address - Country:US
Practice Address - Phone:903-597-2273
Practice Address - Fax:903-597-2466
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1608259Medicaid
TX8A8900Medicare ID - Type Unspecified