Healthcare Provider Details

I. General information

NPI: 1629216619
Provider Name (Legal Business Name): GAYLE LANIER R.N., M.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 RUCKER AVE SUITE 208
EVERETT WA
98201-3900
US

IV. Provider business mailing address

3020 RUCKER AVE SUITE 208
EVERETT WA
98201-3900
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5202
  • Fax:
Mailing address:
  • Phone: 425-339-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN 00132496
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: