Individual
CARRIE L LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1 UNIVERSITY BLVD, LA GRANDE, OR 97850-2807
(541) 962-3524
(541) 962-3825
Mailing address
1 UNIVERSITY BLVD, LA GRANDE, OR 97850-2807
(541) 962-3524
(541) 962-3825
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200250079NP FNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058518019
REGENCE BLUE CROSS BS
OR
05
—
237220
—
OR
Enumeration date
10/31/2006
Last updated
11/10/2010
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