Provider Demographics
NPI:1497752943
Name:LANE, TERRY ANN (NP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:LANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 MATHISON DR
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8353
Mailing Address - Country:US
Mailing Address - Phone:208-263-9096
Mailing Address - Fax:
Practice Address - Street 1:606 N 3RD AVE STE 101
Practice Address - Street 2:FAMILY HEALTH CENTER
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1594
Practice Address - Country:US
Practice Address - Phone:208-263-1435
Practice Address - Fax:208-263-4580
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-236A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1341982Medicare ID - Type Unspecified
IDS56986Medicare UPIN