Individual
JADEYN LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1336 E EMPIRE ST, BLOOMINGTON, IL 61701-3420
(309) 863-5454
Mailing address
2412 E WASHINGTON ST STE 4A, BLOOMINGTON, IL 61704-1613
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041.440517
IL
163WC0200X
Critical Care Medicine Registered Nurse
041.440517
IL
163WE0003X
Emergency Registered Nurse
041.440517
IL
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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