Healthcare Provider Details

I. General information

NPI: 1841123189
Provider Name (Legal Business Name): LANEY MARIE FANNING COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N 10TH ST
SPEARFISH SD
57783-2203
US

IV. Provider business mailing address

28501 SD HIGHWAY 73
MARTIN SD
57551-5609
US

V. Phone/Fax

Practice location:
  • Phone: 605-642-2716
  • Fax:
Mailing address:
  • Phone: 605-642-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberNA
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: