| NPI | 1568199867 |
|---|---|
| Former Name | LACEY ANNE DELORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704322011NSA220KV) |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2022-11-10 |