Organization
SANCTUM INTEGRATED HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NINA C. LANE (NURSE PRACTITIONER)
(866) 472-6288
Entity
Organization
Contact information
Practice address
224 E MAIN ST STE 119, ELKTON, MD 21921-5790
(866) 472-6288
(856) 389-5716
Mailing address
224 E MAIN ST STE 119, ELKTON, MD 21921-5790
(866) 472-6288
(856) 389-5716
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
907607700
—
MD
01
—
L04095926355682
DL
NJ
Enumeration date
05/10/2021
Last updated
09/02/2022
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