Individual
MIKENZIE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11946 STANDING STONE DR, GRETNA, NE 68028-8094
(402) 354-2273
(402) 815-4510
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(102) 354-2100
(402) 354-2155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2634
NE
363A00000X
Physician Assistant
—
—
Other
Enumeration date
10/16/2021
Last updated
01/31/2025
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