Individual
KIRT LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPC
Contact information
Practice address
1408 12TH AVENUE, LONGVIEW, WA 98632-3822
(360) 998-3050
(360) 200-6736
Mailing address
PO BOX 2394, LONGVIEW, WA 98632
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2154878
—
WA
Enumeration date
02/25/2020
Last updated
09/18/2023
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