Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 14070012 | AZ |
Y | 176B00000X | Midwife | 190 | AZ |
NPI | 1053710897 |
---|---|
Provider Name | Caitlyn Laney |
First Address | Queen Creek, AZ 85143-3451 |
Second Address | Gilbert, AZ 85297-1503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 18/08/2014 |