Healthcare Provider Details

I. General information

NPI: 1114984515
Provider Name (Legal Business Name): PATRICIA KAY LACY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 JAMESWAY
FORT ATKINSON WI
53538-2805
US

IV. Provider business mailing address

1429 JAMESWAY
FORT ATKINSON WI
53538-2805
US

V. Phone/Fax

Practice location:
  • Phone: 920-568-0480
  • Fax:
Mailing address:
  • Phone: 920-568-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: