Provider Demographics
NPI:1083299721
Name:BREINIG, LACEY ANN (LVN)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:BREINIG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:ANN
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5221 CHOWCHILLA MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-9336
Mailing Address - Country:US
Mailing Address - Phone:209-769-6793
Mailing Address - Fax:
Practice Address - Street 1:5300 HWY 49 N
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9336
Practice Address - Country:US
Practice Address - Phone:209-769-6793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292186164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse