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General NPI Number Information
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NPI Number | 1083410666
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Entity Type | Individual
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Provider Name | LACEY BRIDGET MAUDE CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 1112 S MILL ST
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City | NEW CASTLE
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State | PA
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Zip | 16101-4629
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Country | US
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Telephone | 724-685-4564
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Fax | 724-657-8563
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Provider Business Mailing Address
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Address Line | 100 SHENANGO AVE
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City | SHARON
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State | PA
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Zip | 16146-1503
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Country | US
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Telephone | 724-658-4564
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Fax | 724-657-8563
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN631213
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP032287
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License Number State | PA
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