Provider Demographics
NPI:1487225645
Name:ALSTON, LACEY RAE (CRNP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:RAE
Last Name:ALSTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:COAL CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15423-1065
Mailing Address - Country:US
Mailing Address - Phone:724-938-7466
Mailing Address - Fax:412-531-2948
Practice Address - Street 1:300 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:COAL CENTER
Practice Address - State:PA
Practice Address - Zip Code:15423-1065
Practice Address - Country:US
Practice Address - Phone:724-938-7466
Practice Address - Fax:412-531-2948
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily