Individual
MARY KAY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
900 HILLIGOSS BLVD SE, FOSSTON, MN 56542-1542
(218) 435-1133
(218) 435-1134
Mailing address
900 HILLIGOSS BLVD SE, FOSSTON, MN 56542-1542
(218) 435-1133
(218) 435-1134
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R15886-4
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1034717
PREFERRED ONE NUMBER
MN
01
—
373T8LA
BLUE CROSS NUMBER
MN
Enumeration date
10/11/2006
Last updated
07/08/2007
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