Provider Demographics
NPI:1386058386
Name:LAIL, MATTHEW D (CRNA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:LAIL
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:505 NE 87TH AVE
Mailing Address - Street 2:SUITE 46.5
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1989
Mailing Address - Country:US
Mailing Address - Phone:360-828-5396
Mailing Address - Fax:360-828-5455
Practice Address - Street 1:505 NE 87TH AVE
Practice Address - Street 2:SUITE 46.5
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1989
Practice Address - Country:US
Practice Address - Phone:360-828-5396
Practice Address - Fax:360-828-5455
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2023-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60500709367500000X
WARN60063340163W00000X
ORRN200743638163W00000X
AZRN13946163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse