Individual
MIKELLA RENEE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5802 TOWNSEND PL, CHEYENNE, WY 82009-4143
(307) 256-6933
Mailing address
5802 TOWNSEND PL, CHEYENNE, WY 82009-4143
(307) 256-6933
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
WY
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Enumeration date
05/09/2015
Last updated
08/04/2015
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