Individual
LACEY BLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
600 GRESHAM DR, NORFOLK, VA 23507-1904
(757) 388-8000
Mailing address
1968 HIDDEN VALLEY DR, VIRGINIA BEACH, VA 23464-6937
(920) 707-0125
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
136160
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024181458
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001275956
RN LICENSE
VA
Enumeration date
04/29/2021
Last updated
05/22/2023
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