MEDICARE: LACIN STANSBURY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP128428	TX

General Provider Information

NPI Number	:	1548625064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACIN STANSBURY NP

Provider Business Mailing Address
First Line	:	3406 COLLEGE ST STE 200
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-4612
Country	:	US
Telephone Number	:	409-813-1677
Fax Number	:	409-736-7167

Provider Business Practice Location Address
First Line	:	2200 HIGHWAY 365
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-5506
Country	:	US
Telephone Number	:	409-813-1677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	12/31/2024

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Directions to “ LACIN STANSBURY NP” Practice Location

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