Healthcare Provider Details

I. General information

NPI: 1407760929
Provider Name (Legal Business Name): LACEY MICHELLE LAINE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 HOSBROOK RD STE 320
CINCINNATI OH
45236-2908
US

IV. Provider business mailing address

83 MILLER LN
FORT THOMAS KY
41075-1838
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax:
Mailing address:
  • Phone: 513-374-2159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0043529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: