Individual
NICOLE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1616 NE 16TH WAY, APT 308, GRESHAM, OR 97030-4272
(503) 492-4903
Mailing address
1616 NE 16TH WAY, APT 308, GRESHAM, OR 97030-4272
(503) 492-4903
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
2000940759RN
OR
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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