Individual
LACY NEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5737 SE HAROLD ST, PORTLAND, OR 97206-5526
(815) 531-9061
Mailing address
5737 SE HAROLD ST, PORTLAND, OR 97206-5526
(815) 531-9061
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201604044LPN
OR
Other
Enumeration date
02/09/2017
Last updated
02/09/2017
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