Healthcare Provider Details

I. General information

NPI: 1336826114
Provider Name (Legal Business Name): JALYNN ALEXANDRIA LACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N CANFIELD NILES RD
YOUNGSTOWN OH
44515-2343
US

IV. Provider business mailing address

410 FAIRMOUNT AVE NE
WARREN OH
44483-5223
US

V. Phone/Fax

Practice location:
  • Phone: 330-642-8242
  • Fax:
Mailing address:
  • Phone: 330-979-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.181519
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: