Individual
LACY BERKSHIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2240 WINROW RD, USA MEDDAC, RWBAHC, FORT HUACHUCA, AZ 85631
(520) 533-3634
Mailing address
2240 WINROW AVE, USA MEDDAC, RWBAHC, FORT HUACHUCA, AZ 85613
(520) 533-3634
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP042484
AZ
Other
Enumeration date
02/19/2016
Last updated
05/06/2016
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