Individual
JEFFERY DALE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5000
Mailing address
5210 MCLEOD RD, LUMBERTON, NC 28358-8509
(910) 671-3671
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
176399
NC
Other
Enumeration date
12/14/2010
Last updated
12/14/2010
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