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General NPI Number Information
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NPI Number | 1255054631
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Entity Type | Individual
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Provider Name | LACY JAY NASSEH FNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 2255 YGNACIO VALLEY RD STE T35
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3343
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Country | US
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Telephone | 925-681-9246
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 YGNACIO VALLEY RD STE T
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3343
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Country | US
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Telephone | 925-954-8209
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Fax | 925-891-4292
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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 | 95120763
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License Number State | CA
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