Individual
MRS. CRISTY M LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS FNP
Contact information
Practice address
120 W MAIN ST, ELMWOOD, IL 61529
(309) 742-2921
(309) 742-8411
Mailing address
615 N PROMENADE ST, HAVANA, IL 62644-1243
(309) 543-6600
(309) 543-2089
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209003603
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099052
HEALTH ALLIANCE
IL
01
—
198663
HEALTHLINK
IL
01
—
500011117
RR MEDICARE
—
01
—
7200613
BCBS OF ILLINOIS
IL
Enumeration date
04/05/2006
Last updated
10/03/2016
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