Individual
ELLISA LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3435 N WOLVERINE DR, WASILLA, AK 99654-2704
(907) 631-3830
Mailing address
3435 N WOLVERINE DR, WASILLA, AK 99654-2704
(907) 631-3830
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
6962
AK
Other
Enumeration date
07/29/2013
Last updated
07/29/2013
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