Provider Demographics
NPI:1548743487
Name:LOUDON, LACY (RN BSN)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:LOUDON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 CATALPA CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2428
Mailing Address - Country:US
Mailing Address - Phone:563-580-1497
Mailing Address - Fax:
Practice Address - Street 1:1515 HOMMEN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:WI
Practice Address - Zip Code:53531-9678
Practice Address - Country:US
Practice Address - Phone:563-580-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI218269-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health