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Individual

LACY JO NICHOLS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
927 BROADWAY ST, QUINCY, IL 62301-2719
(217) 224-6423
(217) 223-9370
Mailing address
1005 BROADWAY ST, QUINCY, IL 62301-2834

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041369541
IL
363LN0000X
Neonatal Nurse Practitioner
Primary
209028825
IL

Other

Enumeration date
03/06/2022
Last updated
04/25/2024
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