Healthcare Provider Details

I. General information

NPI: 1053659524
Provider Name (Legal Business Name): DEIRDRE MICHELLE LACY-HUNTER RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEIRDRE MICHELLE LACY RT

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

IV. Provider business mailing address

1727 JOFFRE AVE
TOLEDO OH
43607-1613
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-3111
  • Fax:
Mailing address:
  • Phone: 419-536-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number256240
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberR8866066
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number97527
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRHM00096687
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRAD02210
License Number StateRI
# 6
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberMRT5368
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: