Individual
JACLYNN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2100 BULL ST, COLUMBIA, SC 29201-2104
(803) 898-1832
Mailing address
2100 BULL ST, COLUMBIA, SC 29201-2104
(803) 898-1832
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
25100
SC
Other
Enumeration date
09/22/2015
Last updated
09/22/2015
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