Provider Demographics
NPI:1114635703
Name:RUGG, LACEY MARIE
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:MARIE
Last Name:RUGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3025
Mailing Address - Country:US
Mailing Address - Phone:801-792-4661
Mailing Address - Fax:
Practice Address - Street 1:1826 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3025
Practice Address - Country:US
Practice Address - Phone:801-792-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727435164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse