Individual
MARY K LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4525 3RD AVE SE STE 200, LACEY, WA 98503-1010
(360) 754-3934
(360) 943-8023
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP60325583
WA
Other
Enumeration date
05/31/2013
Last updated
05/20/2021
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