Individual
MRS. LACY B IHDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.C
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-5526
(920) 926-8963
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8343
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5864-33
WI
Other
Enumeration date
06/27/2014
Last updated
10/21/2020
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