Provider Demographics
NPI:1295362960
Name:DEBUSK, LACEY RENEE
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:RENEE
Last Name:DEBUSK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:RENEE
Other - Last Name:PRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:337 TRIGOOD DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2227
Mailing Address - Country:US
Mailing Address - Phone:307-251-7568
Mailing Address - Fax:
Practice Address - Street 1:337 TRIGOOD DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2227
Practice Address - Country:US
Practice Address - Phone:307-251-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care