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General NPI Number Information
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NPI Number | 1194446617
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Entity Type | Individual
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Provider Name | LACEY JEAN BARTA
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Gender | Female
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Dates
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Enumeration Date | 09/05/2022
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 5355 W CHANDLER BLVD STE 3
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City | CHANDLER
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State | AZ
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Zip | 85226-8603
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Country | US
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Telephone | 480-734-9581
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Fax |
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Provider Business Mailing Address
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Address Line | 5355 W CHANDLER BLVD STE 3
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City | CHANDLER
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State | AZ
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Zip | 85226-8603
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Country | US
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Telephone | 480-734-9581
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F04220494
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 193326
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License Number State | AZ
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