Provider Demographics
NPI:1689205239
Name:LANE, JENNIFER JULIANNE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JULIANNE
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JULIANNE
Other - Last Name:GRANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-0501
Mailing Address - Country:US
Mailing Address - Phone:509-630-1160
Mailing Address - Fax:509-508-5234
Practice Address - Street 1:PO BOX 501
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-0501
Practice Address - Country:US
Practice Address - Phone:509-630-1160
Practice Address - Fax:509-508-5234
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00171098163WL0100X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant