Provider Demographics
NPI:1437678752
Name:HAGGERTY, LACEY RAINNE (ARNP, CNM)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:RAINNE
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:R
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 ORONDO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-6000
Mailing Address - Fax:509-664-4590
Practice Address - Street 1:600 ORONDO AVE STE 1
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2800
Practice Address - Country:US
Practice Address - Phone:509-662-6000
Practice Address - Fax:509-664-4590
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60787438367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife