Individual
LACEY D PROVIDENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
520 E 91ST ST FL 2, BROOKLYN, NY 11236-1021
(347) 232-4288
Mailing address
520 E 91ST ST FL 2, BROOKLYN, NY 11236-1021
(347) 232-4288
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
82954601
NY
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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