Individual
JESSE LYNN LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
335 ALLOWAY FRIESBURG RD, BRIDGETON, NJ 08302-5527
(609) 805-2578
Mailing address
335 ALLOWAY FRIESBURG RD, BRIDGETON, NJ 08302-5527
(609) 805-2578
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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