| NPI | 1174946032 |
|---|---|
| Former Name | LACEY RENEE ANGELLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: LA AP07765) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: LA RN119251) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2024-08-22 |