MEDICARE: DR. JANE ELOISE LACEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	11658	NV

General Provider Information

NPI Number	:	1881654689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE ELOISE LACEY MD

Provider Business Mailing Address
First Line	:	1525 VISTA LN
Second Line	:	120
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4626
Country	:	US
Telephone Number	:	775-885-9991
Fax Number	:	775-883-0884

Provider Business Practice Location Address
First Line	:	1525 VISTA LN
Second Line	:	120
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4626
Country	:	US
Telephone Number	:	775-885-9991
Fax Number	:	775-883-0884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/27/2008

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