Provider Demographics
NPI:1679845184
Name:LACEY, ABIGAIL (MSN, CNM)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 ORCUTT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2720
Mailing Address - Country:US
Mailing Address - Phone:619-756-1258
Mailing Address - Fax:
Practice Address - Street 1:4948 ORCUTT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2720
Practice Address - Country:US
Practice Address - Phone:619-756-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236038367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife