Individual
MS. LACEY ANN NORDSIDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1 UNIVERSITY PL, CHRISTOPHER NEWPORT UNIVERSITY - DEPT OF ATHLETICS, NEWPORT NEWS, VA 23606-2949
(757) 286-2389
Mailing address
566 VIRGINIAN DR, NORFOLK, VA 23505-4243
(757) 642-2052
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000906
VA
Other
Enumeration date
04/08/2007
Last updated
07/08/2007
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