Individual
STACY JOELLE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
160 DENTAL CIRCLE, CHAPEL HILL, NC 27599-7064
(919) 966-4095
Mailing address
1312 RODESSA RUN, RALEIGH, NC 27607-6011
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
229867
NC
Other
Enumeration date
06/02/2017
Last updated
06/02/2017
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