Provider Demographics
NPI:1023397775
Name:FOX-SMITH, LACEY RAE (PNP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:RAE
Last Name:FOX-SMITH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ASSEMBLY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-9608
Mailing Address - Country:US
Mailing Address - Phone:585-624-4520
Mailing Address - Fax:
Practice Address - Street 1:30 ASSEMBLY DR STE 101
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:NY
Practice Address - Zip Code:14506-9608
Practice Address - Country:US
Practice Address - Phone:585-624-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630457163W00000X
NY382380363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse