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Individual

MARY E LANE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
300 N WILLSON, SUITE 2001, BOZEMAN, MT 59715-3572
(406) 587-0681
(406) 587-9011
Mailing address
300 N WILLSON, SUITE 2001, BOZEMAN, MT 59715-3572
(406) 587-0681
(406) 587-9011

Taxonomy

Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
RN18707
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0434538
MT
01
P74886
MEDICARE UPIN
MT
Enumeration date
03/16/2006
Last updated
07/09/2007
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