Individual
MELISSA DIANE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4909 NW 27TH CT # B, GAINESVILLE, FL 32606-6590
(352) 377-6008
(352) 377-7364
Mailing address
4909 NW 27TH CT # B, GAINESVILLE, FL 32606-6590
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA46448
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C3924
BCBS PROVIDER NUMBER
FL
01
—
MA46448
LISENCE NUMBER
FL
Enumeration date
11/30/2006
Last updated
07/08/2007
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