Provider Demographics
NPI:1619638483
Name:LANIER, KAULEN
Entity Type:Individual
Prefix:
First Name:KAULEN
Middle Name:
Last Name:LANIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15117 MAIN STREET
Mailing Address - Street 2:SUITE 205 PMB #850
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012
Mailing Address - Country:US
Mailing Address - Phone:813-853-2778
Mailing Address - Fax:
Practice Address - Street 1:18601 ALDERWOOD MALL PKWY
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8004
Practice Address - Country:US
Practice Address - Phone:813-853-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center