Provider Demographics
NPI:1114143906
Name:PURCELL, LACEY RENE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:RENE
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 9TH ST NE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-7661
Mailing Address - Country:US
Mailing Address - Phone:509-433-1068
Mailing Address - Fax:
Practice Address - Street 1:470 9TH ST NE
Practice Address - Street 2:SUITE 5
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7661
Practice Address - Country:US
Practice Address - Phone:509-433-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00016547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist