Provider Demographics
NPI:1053659524
Name:LACY-HUNTER, DEIRDRE MICHELLE (RT)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:MICHELLE
Last Name:LACY-HUNTER
Suffix:
Gender:F
Credentials:RT
Other - Prefix:MS
Other - First Name:DEIRDRE
Other - Middle Name:MICHELLE
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT
Mailing Address - Street 1:1727 JOFFRE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1613
Mailing Address - Country:US
Mailing Address - Phone:419-536-8041
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN256240247100000X
OHR8866066247100000X
TX97527247100000X
CARHM00096687247100000X
RIRAD02210247100000X
MSMRT5368247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist