Provider Demographics
NPI:1548500580
Name:LANE, BARBARA JO (RN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JO
Last Name:LANE
Suffix:
Gender:F
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NORTHERN VISIONS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-922-9625
Mailing Address - Fax:231-929-5594
Practice Address - Street 1:2400 NORTHERN VISIONS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-922-9625
Practice Address - Fax:231-929-5594
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704191326163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health