Individual
KELLY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
29 NORTHWEST BLVD, NASHUA, NH 03063-4068
(603) 577-2273
(603) 579-5191
Mailing address
PO BOX 3677, NASHUA, NH 03061-3677
(603) 577-7900
(603) 577-7972
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1164
NH
Other
Enumeration date
04/08/2016
Last updated
04/08/2016
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