Healthcare Provider Details

I. General information

NPI: 1902320971
Provider Name (Legal Business Name): LEA NICOLE LACEFIELD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEA NICOLE THOMPSON

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT MARYS AVE # 101
LA PLATA MD
20646-4037
US

IV. Provider business mailing address

10801 BRITTANY LN
LA PLATA MD
20646-3530
US

V. Phone/Fax

Practice location:
  • Phone: 240-257-5436
  • Fax:
Mailing address:
  • Phone: 240-299-4036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR200588
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: