Provider Demographics
NPI:1275963704
Name:LACEY, MORGAN ASHLEY
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ASHLEY
Last Name:LACEY
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 1:3262 SW ESPERANTO ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4622
Mailing Address - Country:US
Mailing Address - Phone:954-461-1987
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:3262 SW ESPERANTO ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4622
Practice Address - Country:US
Practice Address - Phone:954-461-1987
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other