Individual
AMY VONGVILATH LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
F-NP
Contact information
Practice address
13808 PROFESSIONAL CENTER DR, HUNTERSVILLE, NC 28078-7948
(704) 377-0246
(704) 892-6638
Mailing address
13808 PROFESSIONAL CENTER DR, HUNTERSVILLE, NC 28078-7948
(704) 377-0246
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5013901
NC
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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