Individual
JACQUELINE BETHANY LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
3905 W FIELDWOOD CT, LECANTO, FL 34461-8387
(518) 929-6467
Mailing address
3905 W FIELDWOOD CT, LECANTO, FL 34461-8387
(518) 929-6467
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
644601
NY
163W00000X
Registered Nurse
Primary
9640014
FL
Other
Enumeration date
07/08/2021
Last updated
04/01/2026
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