| Doctor Name: | LANE MARIE ERICKSON |
| NPI Number: | 1013324367 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA.0003983 |
| Business Practice Address: | 1860 E Egbert St Brighton, CO - 806012475 |
| Business Phone Number: | 3036594000 |
| Business Fax Number: | 3036599306 |
| Mailing Address: | 203 S Rollie Ave, FORT LUPTON |
| State: | CO |
| Postal Code: | 806211508 |
| Phone Number: | 3032864560 |
| Fax Number: | 3032864589 |
| NPI Enumeration Date: | 07/18/2014 |
| NPI Last Update Date: | 10/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA.0003983 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |