| Doctor Name: | KIMBERLY J LANE |
| NPI Number: | 1093765232 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 000708 |
| Business Practice Address: | 320 Pomfret St Putnam, CT - 062601836 |
| Business Phone Number: | 8609286541 |
| Business Fax Number: | 8609636393 |
| Mailing Address: | 320 Pomfret St, PUTNAM |
| State: | CT |
| Postal Code: | 062601836 |
| Phone Number: | 8609286541 |
| Fax Number: | 8609636393 |
| NPI Enumeration Date: | 05/10/2006 |
| NPI Last Update Date: | 01/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 000708 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |