Provider Demographics
NPI:1578842100
Name:TOWNSEND, LACEY MONIQUE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:MONIQUE
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 CHURN CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1148
Mailing Address - Country:US
Mailing Address - Phone:530-221-7474
Mailing Address - Fax:530-226-6329
Practice Address - Street 1:2891 CHURN CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1148
Practice Address - Country:US
Practice Address - Phone:530-221-7474
Practice Address - Fax:530-226-6329
Is Sole Proprietor?:No
Enumeration Date:2011-08-13
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant