MR. JEREMY LANE JR. (NPI# 1144205220) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144205220 |
| Entity Type | Individual |
| Full Name | MR. JEREMY LANE JR. |
| Credential | P.A.-C. |
| Practice Address |
3931 Louisiana Ave S St Louis Park MN 55426-5000 |
| Practice Telephone | 9529933230 |
| Practice Fax Number | 9529931748 |
| Mailing Telephone | 9529933230 |
| Mailing Fax Number | 9529931748 |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2019-03-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
9937 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154695625 | Jeremy David Lane | Counselor | 309 E 3rd St Apt 5, Rome, GA 30161-3194 | 2012-03-01 |
| 1568915452 | Jeremy Lane | Counselor | 982 Mission St, San Francisco, CA 94103-2911 | 2016-07-27 |
| 1013233592 | Jeremy Heath Lane | Pharmacist | 318 Jackson Ave S, Russellville, AL 35653-2207 | 2010-04-09 |
| Street Address |
3931 LOUISIANA AVE S |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55426-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265422927 | Anthony G Bottini | Neurological Surgery | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2005-10-25 |
| 1437797917 | Allison Marie White | Dietitian, Registered | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-12-16 |
| 1083257612 | Kaylie Marie Laplante | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-10-27 |
| 1952960841 | Melissa Ann Moran | Nurse Practitioner | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-06-13 |
| 1205394004 | Maria Kelley Kearney | Occupational Therapist | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2019-03-11 |
| 1043790553 | Jack William Bergman | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-08-15 |
| 1164922910 | Lisa Mary Huset | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2018-02-19 |
| 1184147514 | Avri Ann Bock | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-07-18 |
| 1871013037 | Lorraine Marie Richards | Nurse Practitioner | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-06-20 |
| 1336672930 | Naoko Onizuka | Internal Medicine | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821657545 | Big Brain Concussion Recovery & Chiropractic Pa | Chiropractor | 3313 Republic Ave., St. Louis Park, MN 55426 | 2019-06-06 |
| 1912485095 | Daniel Raies | Optometrist | 8900 Minnesota 7, St Louis Park, MN 55426 | 2018-08-01 |
| 1649756040 | Wayside House, Inc. | Clinic/Center | 1349 Jersey Ave S, St. Louis Park, MN 55426 | 2018-07-18 |
| 1104302884 | Superior Caregivers, LLC | In Home Supportive Care | 1319 Lancaster Ave., St. Louis Park, MN 55426 | 2018-07-16 |
| 1396234266 | Caitlin Kwiatkowski | Behavior Technician | 7010 Mn-7, St.louis Park, MN 55426 | 2018-05-07 |
| 1497244313 | Kelly Ann Clancey | Behavior Technician | 7010 Highway 2, Saint Louis Park, MN 55426 | 2018-05-07 |
| 1770072696 | Ashleigh Hakala | Behavior Technician | 7010 Highway 7 St. Louis Park Mn 55426, St. Louis Park, MN 55426 | 2018-05-07 |
| 1689181521 | Glenda Miles | Registered Nurse | 7316 Cedar Lake Road, Apt 8, St Louis Park, MN 55426 | 2017-12-31 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1447775549 | Belinda Sue Bliss | Marriage & Family Therapist | 3301 Decatur Lane, Saint Louis Park, MN 55426 | 2017-08-09 |
| Find all providers in zip 55426 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699254490 | Lisa Ruff | Physician Assistant | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2018-08-13 |
| 1972037059 | Gregory Allen | Physician Assistant | 5775 Wayzata Blvd Ste 140, St Louis Park, MN 55416-2660 | 2017-04-17 |
| 1386184844 | Melissa Shelendich | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2017-03-03 |
| 1124578620 | Sarah Savengseuksa | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2016-10-07 |
| 1780979104 | Brady Duane Baartman | Physician Assistant | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2011-06-14 |
| 1023168432 | Lucia F Pierson | Physician Assistant | 6465 Wayzata Blvd, Ste 315, St Louis Park, MN 55426-1728 | 2007-01-11 |
| 1730166729 | James N Cavallaro | Physician Assistant | 3931 Louisiana Ave S, St Louis Park, MN 55426-5000 | 2005-12-29 |
| 1982680690 | Angela Woyno | Physician Assistant | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2005-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194120204 | Nathan C Clapper | Physician Assistant | 3580 Arcade St Ste 100, Vadnais Heights, MN 55127-7135 | 2014-10-31 |
| 1003180555 | Elizabeth K Saterenzoller | Physician Assistant | 1015 Marsh Street, Mankato, MN 56002-8673 | 2012-03-01 |
| 1477824472 | Andrea Jo Pitzl | Physician Assistant | 3208 36th Ave Ne, St Anthony, MN 55418-1713 | 2012-01-23 |
| 1447560693 | Jeanine Marie Edstrom | Physician Assistant | 1185 Town Centre Dr Ste 200, Eagan, MN 55123-1343 | 2010-10-20 |
| 1841504792 | Michelle R Aumock | Physician Assistant | 8100 W 78th Street, Ste 230, Edina, MN 55439 | 2010-08-03 |
| 1194042390 | Gerald Frederick Anderson | Physician Assistant | 4060 Haines Rd, #104, Duluth, MN 55811-1746 | 2010-04-27 |
| 1558683904 | Oswaldo Serge | Physician Assistant | 4036 3rd St Nw, Rochester, MN 55901-7564 | 2010-02-25 |
| 1417288945 | Amanda Kay Johnson | Physician Assistant | 201 W Center St Ei-01 Surgical Assistant, Rochester, MN 55902-3003 | 2010-01-22 |
| 1790922755 | Jenelle Cecilia Rock | Physician Assistant | 1950 Northwestern Ave S, Suite 102, Stillwater, MN 55082-7590 | 2009-01-13 |
| 1174775514 | Nathan J Nistler | Physician Assistant | 3580 Arcade Stq, Vadnais Heights, MN 55127-7135 | 2008-10-16 |
| Find all providers with the same taxonomy | ||||
| City | ST LOUIS PARK |
| Zip Code | 55426 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.