Individual
MRS. MARY KATHLEEN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
325 PARK ST, LEBANON, OR 97355-4229
(541) 451-7200
(541) 451-7207
Mailing address
PO BOX 1193, CORVALLIS, OR 97339-1193
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
085-000746
IL
363AM0700X
Medical Physician Assistant
Primary
PA01341
OR
Other
Enumeration date
03/19/2007
Last updated
11/05/2020
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