Individual
MRS. KRISTIN ANNE LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 FRUIT ST, SUITE 3700-B, BOSTON, MA 02114-2621
(617) 726-3770
Mailing address
22 NASHUA AVE, GLOUCESTER, MA 01930-1211
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
267470
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083802516
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/10/2007
Last updated
02/07/2018
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