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NPI Code Detail

MEDICARE: LACEY NICOLE GREENFIELD RN

MEDICARE: LACEY NICOLE GREENFIELD RN
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
1163W00000XRegistered NurseR 0092441OK

General Provider Information

NPI Number : 1902151996
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY NICOLE GREENFIELD RN
Provider Business Mailing Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 580-749-5056
Fax Number : 580-215-5756
Provider Business Practice Location Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 580-749-5056
Fax Number : 580-215-5756
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2012
Last Update Date : 03/12/2024

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