Healthcare Provider Details

I. General information

NPI: 1922746098
Provider Name (Legal Business Name): LACEY DIONNE ANGLIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WALNUT HILL LN
DALLAS TX
75231-4402
US

IV. Provider business mailing address

1089 W EXCHANGE PKWY APT 6110
ALLEN TX
75013-7050
US

V. Phone/Fax

Practice location:
  • Phone: 214-345-6789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1095421
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1095421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: