Individual
AGNES E LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1910 MORRIS AVE, APT 1-C, BRONX, NY 10453-5946
(914) 932-6402
Mailing address
1910 MORRIS AVE, APT 1-C, BRONX, NY 10453-5946
(914) 932-6402
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
249649
NY
Other
Enumeration date
09/15/2016
Last updated
09/15/2016
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