Individual
DR. SHANON RENEE LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
8901 W LINCOLN AVE, WEST ALLIS, WI 53227-2409
(414) 328-7675
Mailing address
102 N WATER ST UNIT 206, MILWAUKEE, WI 53202-6056
(317) 285-9918
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
56999-21
WI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
56999-21
WI
Other
Enumeration date
06/12/2008
Last updated
12/30/2021
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