Provider Demographics
NPI:1679331813
Name:LANE, RACHIEL (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:RACHIEL
Middle Name:
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 1:1807 N WOODBINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4892
Mailing Address - Country:US
Mailing Address - Phone:816-294-7600
Mailing Address - Fax:
Practice Address - Street 1:1807 N WOODBINE RD STE E
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-4892
Practice Address - Country:US
Practice Address - Phone:816-294-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024009299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily