Provider Demographics
NPI:1396403523
Name:LACEY-DAVIS, STACEY SHERISE (RN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:SHERISE
Last Name:LACEY-DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37490 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3503
Mailing Address - Country:US
Mailing Address - Phone:586-480-1438
Mailing Address - Fax:
Practice Address - Street 1:37490 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3503
Practice Address - Country:US
Practice Address - Phone:586-480-1438
Practice Address - Fax:586-983-9797
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704378583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse