Provider Demographics
NPI:1073598462
Name:PITMAN, LACY TWINING (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LACY
Middle Name:TWINING
Last Name:PITMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4017
Mailing Address - Country:US
Mailing Address - Phone:410-535-4488
Mailing Address - Fax:443-771-8114
Practice Address - Street 1:110 HOSPITAL RD STE 111
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4039
Practice Address - Country:US
Practice Address - Phone:410-535-4488
Practice Address - Fax:443-771-8114
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR147334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407239100Medicaid
MD138120ZFBKMedicare PIN