Healthcare Provider Details

I. General information

NPI: 1912574401
Provider Name (Legal Business Name): LACIE CHRISTINE LAMAY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4972 STATE ROUTE 159
GLEN CARBON IL
62034
US

IV. Provider business mailing address

4972 STATE ROUTE 159
GLEN CARBON IL
62034
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-2970
  • Fax: 618-288-3572
Mailing address:
  • Phone: 618-288-2970
  • Fax: 618-288-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209022835
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: