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NPI Code Detail

MEDICARE: MS. CHERYL MARIE LACY A.P.R.N., B.C.

MEDICARE: MS. CHERYL MARIE LACY A.P.R.N., B.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
1363L00000XNurse Practitioner4704203745MI
2363LA2200XAdult Health Nurse Practitioner4704203745MI
3363LP0808XPsychiatric/Mental Health Nurse Practitioner4704203745MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992816797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHERYL MARIE LACY A.P.R.N., B.C.
Provider Business Mailing Address
First Line : 279 SUMMIT DR
Second Line :
City : WATERFORD
State : MI
Zip : 48328-3364
Country : US
Telephone Number : 734-936-2047
Fax Number :
Provider Business Practice Location Address
First Line : 279 SUMMIT DR
Second Line :
City : WATERFORD
State : MI
Zip : 48328-3364
Country : US
Telephone Number : 734-998-7606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 04/10/2014

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