Individual
MRS. PHYLLIS ODELL LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
278 LASALLE LEFALL DR, QUINCY, FL 32351-5324
(850) 539-2888
(850) 539-2766
Mailing address
278 LASALLE LEFALL DR, QUINCY, FL 32351-5324
(850) 539-2888
(850) 539-2766
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
PN5156289
FL
Other
Enumeration date
07/11/2008
Last updated
07/11/2008
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