Individual
NICOLE RENEA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP ADULT GERONTOLOGY
Contact information
Practice address
12401 OLIVE BLVD, SAINT LOUIS, MO 63141-5443
(314) 390-0135
Mailing address
474 BROOKHAVEN CT, O FALLON, MO 63368-9634
(316) 371-6761
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
77185
KS
Other
Enumeration date
12/06/2016
Last updated
09/28/2021
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