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Individual

AQUARIUS M LACEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
39104 PRAIRIE SOUTH DR, GONZALES, LA 70737-9510
(225) 400-1376
Mailing address
39104 PRAIRIE SOUTH DR, GONZALES, LA 70737-9510
(225) 400-1376

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
20130166
LA
163WC1500X
Community Health Registered Nurse
20130166
LA
163WH0200X
Home Health Registered Nurse
20130166
LA

Other

Enumeration date
05/06/2022
Last updated
05/06/2022
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