Healthcare Provider Details

I. General information

NPI: 1679845184
Provider Name (Legal Business Name): ABIGAIL LACEY MSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ELM ST
NEW MILFORD CT
06776-2915
US

IV. Provider business mailing address

4948 ORCUTT AVE
SAN DIEGO CA
92120-2720
US

V. Phone/Fax

Practice location:
  • Phone: 860-210-5535
  • Fax:
Mailing address:
  • Phone: 619-756-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236038
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number588
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: