Healthcare Provider Details

I. General information

NPI: 1053710897
Provider Name (Legal Business Name): CAITLYN LANEY CPM LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S LINDSAY RD
GILBERT AZ
85297-1503
US

IV. Provider business mailing address

1208 W DESERT GLEN DR
QUEEN CREEK AZ
85143-3451
US

V. Phone/Fax

Practice location:
  • Phone: 480-664-7463
  • Fax: 480-664-7467
Mailing address:
  • Phone: 480-747-2837
  • Fax: 480-664-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number14070012
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number190
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: