Healthcare Provider Details

I. General information

NPI: 1487225645
Provider Name (Legal Business Name): LACEY RAE ALSTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N FRANKLIN ST
WASHINGTON PA
15301-4378
US

IV. Provider business mailing address

701 TECHNOLOGY DR STE 150
CANONSBURG PA
15317-9531
US

V. Phone/Fax

Practice location:
  • Phone: 724-222-7240
  • Fax: 412-229-7227
Mailing address:
  • Phone: 412-531-2902
  • Fax: 412-531-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023989
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: