Individual
LACEY NICOLE KEENEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LE
Contact information
Practice address
1623 OAK ST, EUGENE, OR 97401-4022
(541) 221-5175
(541) 221-5175
Mailing address
3950 GOODPASTURE LOOP APT H133, EUGENE, OR 97401-1426
(541) 221-5175
(541) 221-5175
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10199530
OR
Other
Enumeration date
06/24/2019
Last updated
09/12/2019
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