Individual
MISS SAMANTHA COLLEEN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDC
Contact information
Practice address
2000 W MARINE VIEW DR # 2134, EVERETT, WA 98207-2900
(425) 304-4343
Mailing address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/27/2010
Last updated
04/02/2024
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