Individual provider Active NPI

Mary K Lane, ARNP

  • Family Nurse Practitioner
  • Lacey, WA
National Provider Identifier
1437596301
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60325583 Issued in WA
Practice address
4525 3Rd Ave SE Ste 200
Lacey, WA 98503-1010
Phone
(360) 754-3934
Fax
(360) 943-8023
NPI assigned
May 31, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP60325583 WA Primary

Addresses

Primary practice location

4525 3Rd Ave SE Ste 200
Lacey, WA 98503-1010

Mailing address

PO Box 3360
Portland, OR 97208-3360

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mlane99253@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130903000795 WA Practitioner - Nurse Practitioner 6305089731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Washington School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2015 Cooks Hill Rd
Suite 200
Centralia, WA 98531-9074
Phone (360) 330-8939

4525 3Rd Ave SE
Suite 200
Lacey, WA 98503-1010
Phone (360) 754-3934

525 Lilly Rd NE
Olympia, WA 98506-5101

954 Anderson Dr
Suite 102
Aberdeen, WA 98520-1001
Phone (360) 533-6906

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP60325583WAMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: mlane99253@wm.providencedirect.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1437596301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 3RD AVE SE STE 200",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985031010",
            "telephone_number": "360-754-3934",
            "fax_number": "360-943-8023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60325583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mlane99253@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4525 3rd Ave SE Ste 200",
            "city": "Lacey",
            "state": "WA",
            "country_code": "US",
            "postal_code": "985031010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

Verify at the official NPI Registry.