Provider Demographics
NPI:1407272305
Name:BAUER, LACEY MARIE (CD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:MARIE
Last Name:BAUER
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-0002
Mailing Address - Country:US
Mailing Address - Phone:757-349-6618
Mailing Address - Fax:
Practice Address - Street 1:23292 SPRING CREST DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-2688
Practice Address - Country:US
Practice Address - Phone:757-349-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10264374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula