Provider Demographics
NPI:1467727321
Name:DONNELLY, LACI MAE (FNP)
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:MAE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LACI
Other - Middle Name:MAE
Other - Last Name:CLAUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3525 E BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-3434
Practice Address - Country:US
Practice Address - Phone:417-269-1499
Practice Address - Fax:417-269-1459
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012007890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily