Individual
MRS. MARY PENFIELD LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
5369 PINEYWOOD RD, BIRMINGHAM, AL 35242-3424
(205) 991-6426
Mailing address
5369 PINEYWOOD RD, BIRMINGHAM, AL 35242-3424
(205) 991-6426
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-025087
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51529456
BCBS OF AL
AL
01
—
51556190
BCBS OF AL
AL
Enumeration date
02/12/2007
Last updated
07/09/2007
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