Provider Demographics
NPI:1568199867
Name:FELTEN, LACEY ANNE (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANNE
Last Name:FELTEN
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:ANNE
Other - Last Name:DELORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-2505
Mailing Address - Country:US
Mailing Address - Phone:989-450-8857
Mailing Address - Fax:
Practice Address - Street 1:2660 W SUGNET RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-4860
Practice Address - Country:US
Practice Address - Phone:989-832-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704322011NSA220KV363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care