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LAURIE GENE LANE PC-C

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1639156631

Individual Registrant:
 LAURIE GENE LANE PC-C
Gender: F

Location and contact information for practice:
308 MAIN ST  OLATHE, CO 81425 US
Tel: 970-323-6141  Fax: 970-249-8421

Contact information for business:
PO BOX 529  OLATHE, CO 81425-0529 US
Tel: 970-323-6141  Fax: 970-249-8421

Registration Information:
NPI: 1639156631
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
CO142

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
07142003CO05




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