Individual
MS. CHERYL MARIE LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.R.N., B.C.
Contact information
Practice address
279 SUMMIT DR, WATERFORD, MI 48328-3364
(734) 998-7606
Mailing address
279 SUMMIT DR, WATERFORD, MI 48328-3364
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704203745
MI
363LA2200X
Adult Health Nurse Practitioner
4704203745
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704203745
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4824971
—
MI
Enumeration date
08/31/2006
Last updated
04/10/2014
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