Individual
DUSTIN ALEX LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
262 W WAUSAU ST, MERIDIAN, ID 83646-6938
(541) 620-0935
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
59114
ID
367500000X
Certified Registered Nurse Anesthetist
Primary
9071278
ID
Other
Enumeration date
04/02/2025
Last updated
08/20/2025
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