Healthcare Provider Details

I. General information

NPI: 1902842024
Provider Name (Legal Business Name): JANICE E LACEY MSN ANP BC NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HO PLZ
ITHACA NY
14853-3102
US

IV. Provider business mailing address

110 HO PLZ
ITHACA NY
14853-3102
US

V. Phone/Fax

Practice location:
  • Phone: 607-255-6106
  • Fax: 607-254-3503
Mailing address:
  • Phone: 607-255-6106
  • Fax: 607-254-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number3173951
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3014051
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF4010201
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF3014051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: