Individual
SARA LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
144 PENN CIR, GALIVANTS FERRY, SC 29544-8678
(843) 433-2331
Mailing address
144 PENN CIR, GALIVANTS FERRY, SC 29544-8678
(843) 433-2331
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
253204
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0346490902
—
SC
Enumeration date
01/19/2021
Last updated
01/19/2021
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