Individual
CAROL LACKEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 MALLISON FALLS RD, WINDHAM, ME 04062-4101
(207) 592-0810
Mailing address
17 MALLISON FALLS RD, WINDHAM, ME 04062-4101
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN62216
ME
Other
Enumeration date
08/09/2023
Last updated
08/09/2023
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