Provider Demographics
NPI:1376917013
Name:CRYAN, LAYNE SCHNIDER (PA-C)
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:SCHNIDER
Last Name:CRYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:PACKWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98361-0085
Mailing Address - Country:US
Mailing Address - Phone:620-474-1160
Mailing Address - Fax:
Practice Address - Street 1:521 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356-9323
Practice Address - Country:US
Practice Address - Phone:360-497-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005823363A00000X
WAPA60611259261QR1300X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty