Individual
LACEY MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1441 WILKINS CIR, CASPER, WY 82601-1337
(307) 233-2700
(307) 472-2883
Mailing address
1441 WILKINS CIR, CASPER, WY 82601-1337
(307) 233-2700
(307) 472-2883
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1195040
GA
363A00000X
Physician Assistant
Primary
PA1061
WY
Other
Enumeration date
11/14/2022
Last updated
12/11/2024
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