Individual
MR. MICAH LASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4029 NORTHWEST AVE STE 301, BELLINGHAM, WA 98226-9077
(360) 752-0518
Mailing address
4029 NORTHWEST AVE STE 301, BELLINGHAM, WA 98226-9077
(360) 752-0518
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60509731
WA
363AM0700X
Medical Physician Assistant
5224
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60509731
WA STATE PA LICENSE
WA
Enumeration date
10/17/2012
Last updated
03/14/2017
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