Lane, Teresa A

Lane, Teresa A is an individual health care provider with primary practice located at 200 E Pennsylvania Ave , Peoria IL 61603-3089. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Lane, Teresa A can be contacted via phone (309) 624-4000.

Contact Information

Primary practice address
200 E Pennsylvania Ave Peoria IL 61603-3089
Phone: (309) 624-4000
Fax: (309) 624-4010
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 364SA2200X 209008755 Illinois

Profile Details

NPI number 1417247776
LBN Legal business name Lane, Teresa A
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 7th, 2011
Last updated Mar 25th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417247776 NPPES
Illinois MEDICAID 370662569

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