Individual
JACLYN MAUREEN LAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1480 W LANE AVE, COLUMBUS, OH 43221-3919
(614) 533-5500
(614) 533-0103
Mailing address
PO BOX 7527, DUBLIN, OH 43017-0727
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
34.010195
OH
2084N0400X
Neurology Physician
34.010195
OH
2084N0600X
Clinical Neurophysiology Physician
Primary
34.010195
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0061403
—
OH
Enumeration date
07/13/2007
Last updated
08/02/2024
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