Provider Demographics
NPI:1285023549
Name:LIGGETT, LACY (CNA)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:LIGGETT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18551 VIKEN RD
Mailing Address - Street 2:
Mailing Address - City:NEWELL
Mailing Address - State:SD
Mailing Address - Zip Code:57760-5832
Mailing Address - Country:US
Mailing Address - Phone:605-210-0401
Mailing Address - Fax:
Practice Address - Street 1:18551 VIKEN RD
Practice Address - Street 2:
Practice Address - City:NEWELL
Practice Address - State:SD
Practice Address - Zip Code:57760-5832
Practice Address - Country:US
Practice Address - Phone:605-210-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDA036746376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide