Provider Demographics
NPI:1588199103
Name:LACEY, YANETA QUANE (LPT)
Entity Type:Individual
Prefix:
First Name:YANETA
Middle Name:QUANE
Last Name:LACEY
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2751 NAPA VALLEY CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6216
Mailing Address - Country:US
Mailing Address - Phone:707-227-3900
Mailing Address - Fax:707-227-3888
Practice Address - Street 1:2751 NAPA VALLEY CORPORATE DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6216
Practice Address - Country:US
Practice Address - Phone:707-227-3900
Practice Address - Fax:707-227-3888
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA34854167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician