| Doctor Name: | NICOLE LANE |
| NPI Number: | 1063745453 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 2000940759RN |
| Business Practice Address: | 1616 Ne 16th Way Apt 308 Gresham, OR - 970304272 |
| Business Phone Number: | 5034924903 |
| Business Fax Number: | |
| Mailing Address: | 1616 Ne 16th Way, Apt 308 GRESHAM |
| State: | OR |
| Postal Code: | 970304272 |
| Phone Number: | 5034924903 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2009 |
| NPI Last Update Date: | 09/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0200X |
| License Number: | 2000940759RN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Critical Care Medicine |
| Taxonomy Definition: | |