Provider Demographics
NPI:1255926853
Name:LACANLALE, NEIL
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:LACANLALE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7848 23RD LN SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3300
Mailing Address - Country:US
Mailing Address - Phone:657-767-4837
Mailing Address - Fax:
Practice Address - Street 1:7848 23RD LN SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3300
Practice Address - Country:US
Practice Address - Phone:657-767-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95144496163WA2000X
WAAP61318285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator