Provider Demographics
NPI:1235759291
Name:LACY-ANTONELLI, SARA (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LACY-ANTONELLI
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:900 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6804
Mailing Address - Country:US
Mailing Address - Phone:405-516-0276
Mailing Address - Fax:
Practice Address - Street 1:900 NW 12TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-6804
Practice Address - Country:US
Practice Address - Phone:405-516-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK117846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily