Individual
TINA NICHOLE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
400 SW LONGVIEW BLVD STE 200, LEES SUMMIT, MO 64081-2116
(913) 215-5008
Mailing address
400 SW LONGVIEW BLVD STE 200, LEES SUMMIT, MO 64081-2116
(913) 215-5008
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
135267
MO
363L00000X
Nurse Practitioner
Primary
2019043201
MO
363LF0000X
Family Nurse Practitioner
2019043201
MO
Other
Enumeration date
07/31/2019
Last updated
10/25/2021
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