Provider Demographics
NPI:1710404637
Name:LANBAKE, LLC
Entity Type:Organization
Organization Name:LANBAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELI
Authorized Official - Middle Name:AN
Authorized Official - Last Name:LANCLOS
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:409-853-1288
Mailing Address - Street 1:8480 CENTRAL MALL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642
Mailing Address - Country:US
Mailing Address - Phone:409-729-2071
Mailing Address - Fax:877-747-0142
Practice Address - Street 1:8480 CENTRAL MALL DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8001
Practice Address - Country:US
Practice Address - Phone:409-853-1288
Practice Address - Fax:866-275-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty