Individual
TRACY ELAINE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-CNP
Contact information
Practice address
20169 E 960 RD, HAMMON, OK 73650-5032
(580) 309-0461
Mailing address
20169 E 960 RD, HAMMON, OK 73650-5032
(580) 309-0461
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71743
OK
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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