Individual
CAROLYN GRANT LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
640 S STATE ST, DOVER, DE 19901-3530
(302) 674-4700
Mailing address
PO BOX 10925, WILMINGTON, DE 19850-0925
(302) 709-4587
(302) 709-2402
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
L1-0014393
DE
367500000X
Certified Registered Nurse Anesthetist
Primary
L6-0A00205
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046452
AANA NUMBER
DE
Enumeration date
09/20/2005
Last updated
02/12/2013
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