Individual
KRYSTAL J LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
710 JOY DR, FORT MILL, SC 29715-8402
(803) 322-6548
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209-033232
IL
363L00000X
Nurse Practitioner
21101
SC
363LF0000X
Family Nurse Practitioner
17563
WI
363LF0000X
Family Nurse Practitioner
Primary
21101
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100386818
—
WI
Enumeration date
05/01/2017
Last updated
04/16/2026
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