Provider Demographics
NPI:1548979164
Name:LANE, BRITTANIE K-LYN (FNP-C)
Entity type:Individual
Prefix:
First Name:BRITTANIE
Middle Name:K-LYN
Last Name:LANE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1670
Mailing Address - Country:US
Mailing Address - Phone:509-654-3062
Mailing Address - Fax:
Practice Address - Street 1:715 N PARK CTR
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1174
Practice Address - Country:US
Practice Address - Phone:509-698-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61370756363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care