Individual
MICKI G LACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390
(214) 645-8000
Mailing address
PO BOX 845347, DALLAS, TX 75284-7208
(214) 645-8000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
504641
TX
Other
Enumeration date
08/16/2005
Last updated
08/15/2019
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