Individual
MISS LACEY MARIE CARLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1306 GEMINI CIR STE 2, OTTAWA, IL 61350
(815) 433-0850
Mailing address
725 SCHOOL ST STE A, MORRIS, IL 60450-1207
(815) 705-1405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.003635
IL
363AS0400X
Surgical Physician Assistant
085003635
IL
Other
Enumeration date
10/12/2009
Last updated
06/23/2023
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