Individual
LACEY TUDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8260 ATLEE RD, EMERGENCY DEPT., MECHANICSVILLE, VA 23116-1844
(804) 764-6300
(804) 764-6562
Mailing address
38935 ANN ARBOR RD, CREDENTIALING DEPT, LIVONIA, MI 48150-3397
(734) 805-0488
(866) 250-6385
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004486
VA
Other
Enumeration date
01/29/2014
Last updated
01/29/2014
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