Provider Demographics
NPI:1609534940
Name:LANE, BAMBI LEE (APRN)
Entity type:Individual
Prefix:
First Name:BAMBI
Middle Name:LEE
Last Name:LANE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N HART ST
Mailing Address - Street 2:
Mailing Address - City:MEADE
Mailing Address - State:KS
Mailing Address - Zip Code:67864-6402
Mailing Address - Country:US
Mailing Address - Phone:620-873-2112
Mailing Address - Fax:
Practice Address - Street 1:119 N HART ST
Practice Address - Street 2:
Practice Address - City:MEADE
Practice Address - State:KS
Practice Address - Zip Code:67864-6402
Practice Address - Country:US
Practice Address - Phone:620-873-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80744-102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily