Individual
LANE MARIE BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1860 E EGBERT ST, BRIGHTON, CO 80601-2475
(303) 659-4000
(303) 659-9306
Mailing address
203 S ROLLIE AVE, BILLING DEPT - CREDENTIALIST, FORT LUPTON, CO 80621-1508
(303) 286-4560
(303) 286-4589
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA.0003983
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96781386
—
CO
Enumeration date
07/18/2014
Last updated
08/24/2016
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