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1669756177
MCTISA MICHELLE LANE
FORT LIBERTY, NC
NPI
1669756177
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: NC 5005342)
Enumeration Date
2011-10-03
Last Update Date
2024-07-16
Business Address
MCTISA MICHELLE LANE FNP
2817 REILLY ST
FORT LIBERTY, NC 28310-4056
Phone number: 910-907-2575
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Mailing Address
MCTISA MICHELLE LANE FNP
BLDG 5-4257 BASTOGNE ST
FORT LIBERTY, NC 28310-8862
Phone number: 910-907-2575
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