Provider Demographics
NPI:1700388196
Name:LANEY, ANGELA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
Last Name:LANEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:DELOACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7308 BRIDGEPORT WAY W STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8000
Mailing Address - Country:US
Mailing Address - Phone:253-582-7257
Mailing Address - Fax:253-582-1617
Practice Address - Street 1:7308 BRIDGEPORT WAY W STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-582-7257
Practice Address - Fax:253-582-1617
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60903290363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical