Individual
LISA RENEE LACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
6701 JEFFERSON ST NE, ALBUQUERQUE, NM 87109-4318
(505) 727-6200
Mailing address
6701 JEFFERSON ST NE, ALBUQUERQUE, NM 87109-4318
(505) 727-6200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
818418
NV
363LF0000X
Family Nurse Practitioner
Primary
CNP-01735
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CNP-01735
NM LICENSE
NM
Enumeration date
02/01/2011
Last updated
12/06/2024
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