Provider Demographics
NPI:1437425345
Name:WRIGHT, LACEY NICOLE
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:NICOLE
Last Name:WRIGHT
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 1:461 LILLIAN AVE
Mailing Address - Street 2:#3
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2163
Mailing Address - Country:US
Mailing Address - Phone:315-863-7160
Mailing Address - Fax:
Practice Address - Street 1:461 LILLIAN AVE
Practice Address - Street 2:#3
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2163
Practice Address - Country:US
Practice Address - Phone:315-863-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301347-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse