Individual
COURTNEY LACEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7549 TOLLHOUSE RD, CLOVIS, CA 93619-9784
(559) 295-9700
Mailing address
PO BOX 617, FRIANT, CA 93626-0617
(559) 760-9298
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
E1649660
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E1649660
DRIVE LICENSE
CA
Enumeration date
01/28/2021
Last updated
01/28/2021
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