Individual
KIMBERLY J LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
320 POMFRET ST, PUTNAM, CT 06260-1836
(860) 928-6541
(860) 963-6393
Mailing address
320 POMFRET ST, PUTNAM, CT 06260-1836
(860) 928-6541
(860) 963-6393
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
000708
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000708
APRN LICENSE NUMBER
CT
05
—
4007084
—
CT
Enumeration date
05/10/2006
Last updated
10/01/2019
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