Individual
JESSICA LYNN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
20225 E 9 MILE RD, SAINT CLAIR SHORES, MI 48080-1700
(313) 600-5349
Mailing address
20225 E 9 MILE RD, SAINT CLAIR SHORES, MI 48080-1700
(586) 772-1090
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
4704342324
MI
363LP0200X
Pediatric Nurse Practitioner
Primary
4704342324
MI
Other
Enumeration date
12/14/2021
Last updated
10/26/2022
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