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Individual
LISA GABRIEL LANE
Active
Individual
LISA GABRIEL LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
515
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042472266
TRICARE CHAMPUS
—
01
—
4142200
MVP HEALTH CARE
—
01
—
44944
HEALTHY START
—
01
—
57183
FALLON COMMUNITY HEALTH
—
01
—
8300399
EVERCARE
—
01
—
AP0278
MEDICARE B
—
Enumeration date
04/27/2006
Last updated
08/29/2018
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