Individual
CAROLYN JO LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
441 N WABASH AVE, MARION, IN 46952-2612
(765) 660-6411
Mailing address
330 NORTH WABASH AVE, SUITE G20, MARION, IN 46952-2600
(765) 660-7600
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002663A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000579524
ANTHEM
—
05
—
200916820
—
IN
Enumeration date
08/04/2008
Last updated
08/01/2013
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