Individual
LACY JAE WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3457 FM 819, DIBOLL, TX 75941-4707
(936) 239-6055
Mailing address
3457 FM 819, DIBOLL, TX 75941-4707
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
233648
TX
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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