Provider Demographics
NPI:1447590385
Name:BRACY, LANESHA (NP)
Entity Type:Individual
Prefix:MS
First Name:LANESHA
Middle Name:
Last Name:BRACY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LANESHA
Other - Middle Name:TILENA
Other - Last Name:THOMAS BRACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:670 9TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6249
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:38883 HWY 299
Practice Address - Street 2:
Practice Address - City:WILLOW CREEK
Practice Address - State:CA
Practice Address - Zip Code:95573
Practice Address - Country:US
Practice Address - Phone:530-629-3111
Practice Address - Fax:530-629-3122
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010412363L00000X
LAAP07155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily