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Individual

JOSEPH R. LACY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
C.R.N.A

Contact information

Practice address
1000 N OAK AVE, MARSHFIELD, WI 54449-3505
(715) 387-5511
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
113499-030
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
044383
CRNA RECERTIFICATION CARD
01
430061296
RAIL ROAD MEDICARE
05
43333400
WI
Enumeration date
12/13/2005
Last updated
07/27/2023
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