Basic Information
| Provider Information | |||||||||
| NPI: | 1104865658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANIER | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967960337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Practice Location | |||||||||
| Address1: | 4643 WAIMEA CANYON DRIVE | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967960337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | AZ26887 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD165194 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 500666243 | 05 | OR | MEDICAID |