Individual
LAURA M LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
580 W COLLEGE AVE, MARQUETTE, MI 49855-2705
(906) 225-3406
(906) 225-3094
Mailing address
3138 N LAKESHORE BLVD, MARQUETTE, MI 49855-2025
(906) 226-6008
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
201901511CRNA
OR
367500000X
Certified Registered Nurse Anesthetist
4704125107
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104563202
—
MI
01
—
LL125107
BLUESHIELD PIN
MI
01
—
P00108337
RAILROAD MEDICARE PIN
MI
Enumeration date
11/17/2005
Last updated
10/19/2021
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