Individual
MICHAEL LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2542 BODIE MOUNTAIN RD, COLVILLE, WA 99114-9663
(509) 732-4037
Mailing address
2542 BODIE MOUNTAIN RD, COLVILLE, WA 99114-9663
(509) 732-4037
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
09/09/2020
Last updated
09/09/2020
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