Provider Demographics
NPI:1356390454
Name:LANE, MIEKE DENISE (DO)
Entity type:Individual
Prefix:
First Name:MIEKE
Middle Name:DENISE
Last Name:LANE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14508 NE 20TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6424
Mailing Address - Country:US
Mailing Address - Phone:360-433-0022
Mailing Address - Fax:360-433-6159
Practice Address - Street 1:900 NE 139TH ST STE 206
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2519
Practice Address - Country:US
Practice Address - Phone:360-487-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO25698207V00000X
WAOP00002124207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278045Medicaid
OR278045Medicaid
132678Medicare ID - Type Unspecified