Individual
MR. JASON TODD LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
215 MARION AVE, MCCOMB, MS 39648-2705
(601) 249-5500
(601) 249-1709
Mailing address
1210 PARKLANE RD, APT 7D, MCCOMB, MS 39648-4904
(601) 347-2739
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R852446
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09724257
—
MS
Enumeration date
08/11/2006
Last updated
02/07/2019
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