Provider Demographics
NPI:1598208613
Name:WOODS, LACEY LYNN
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:LYNN
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 STATE ROUTE 93
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45656-9668
Mailing Address - Country:US
Mailing Address - Phone:740-418-4428
Mailing Address - Fax:
Practice Address - Street 1:545 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:OH
Practice Address - Zip Code:45656-9668
Practice Address - Country:US
Practice Address - Phone:740-418-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401672070714376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide