Healthcare Provider Details

I. General information

NPI: 1548625064
Provider Name (Legal Business Name): LACIN STANSBURY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HIGHWAY 365
NEDERLAND TX
77627-5506
US

IV. Provider business mailing address

3406 COLLEGE ST STE 200
BEAUMONT TX
77701-4612
US

V. Phone/Fax

Practice location:
  • Phone: 409-813-1677
  • Fax:
Mailing address:
  • Phone: 409-813-1677
  • Fax: 409-736-7167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: