Healthcare Provider Details

I. General information

NPI: 1295924793
Provider Name (Legal Business Name): REBECCA W. LACIK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 FAIRGROVE CHURCH RD
HICKORY NC
28602-9617
US

IV. Provider business mailing address

810 FAIRGROVE CHURCH RD
HICKORY NC
28602-9617
US

V. Phone/Fax

Practice location:
  • Phone: 828-326-3000
  • Fax:
Mailing address:
  • Phone: 828-326-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number146172
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number397
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7002101
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier1295924793
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier147VC
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: