Individual
KEVIN LAMONT LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7149 JENNINGS RD NE, LELAND, NC 28451-9431
(910) 231-5770
Mailing address
7149 JENNINGS RD NE, LELAND, NC 28451-9431
(910) 231-5770
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
83-0638824
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83-0638824
—
NC
Enumeration date
05/24/2018
Last updated
05/24/2018
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