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1265847305
LACY B IHDE
FOND DU LAC, WI
NPI
1265847305
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: WI 5864-33)
Enumeration Date
2014-06-27
Last Update Date
2020-10-21
Business Address
Mrs. LACY B IHDE N.P.C
420 E DIVISION ST
FOND DU LAC, WI 54935-4560
Phone number: 920-926-5526
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Mailing Address
Mrs. LACY B IHDE N.P.C
420 E DIVISION ST
FOND DU LAC, WI 54935-4560
Phone number: 920-926-8343
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