Healthcare Provider Details

I. General information

NPI: 1083410666
Provider Name (Legal Business Name): LACEY BRIDGET MAUDE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S MILL ST
NEW CASTLE PA
16101-4629
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-685-4564
  • Fax: 724-657-8563
Mailing address:
  • Phone: 724-658-4564
  • Fax: 724-657-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN631213
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP032287
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: