Individual
MS. BRENDA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2359 N TRIPHAMMER RD, ITHACA, NY 14850-1059
(607) 257-1705
(607) 257-3163
Mailing address
8 BRENTWOOD DR STE A, ITHACA, NY 14850-1871
(607) 257-2116
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
332286
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02393520
—
NY
01
—
BB7606
MEDICARE ID
—
Enumeration date
04/11/2006
Last updated
04/10/2019
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