Individual
MRS. LACEY DIANE MAUL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ENP, FNP
Contact information
Practice address
1907 W SYCAMORE ST, KOKOMO, IN 46901-5148
(765) 456-5433
Mailing address
16776 HAREWOOD DR E, NOBLESVILLE, IN 46060-4047
(317) 313-1922
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
F06170594
IN
363L00000X
Nurse Practitioner
Primary
E08170009
IN
Other
Enumeration date
08/14/2017
Last updated
09/10/2017
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