MEDICARE: MRS. LACEY MONIQUE TOWNSEND PA-C

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	363A00000X	Physician Assistant	PA21753	CA

General Provider Information

NPI Number	:	1578842100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LACEY MONIQUE TOWNSEND PA-C

Provider Business Mailing Address
First Line	:	2891 CHURN CREEK RD STE A
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96002-1148
Country	:	US
Telephone Number	:	530-221-7474
Fax Number	:	530-226-6329

Provider Business Practice Location Address
First Line	:	2891 CHURN CREEK RD STE A
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96002-1148
Country	:	US
Telephone Number	:	530-221-7474
Fax Number	:	530-226-6329

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

Provider Enumeration Date	:	08/13/2011
Last Update Date	:	08/13/2011

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