Provider Demographics
NPI:1750817847
Name:LACEY-WILLIS, SHEILA (RN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:LACEY-WILLIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24263 LATHRUP BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2838
Mailing Address - Country:US
Mailing Address - Phone:248-388-9524
Mailing Address - Fax:248-557-8115
Practice Address - Street 1:24263 LATHRUP BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2838
Practice Address - Country:US
Practice Address - Phone:248-388-9524
Practice Address - Fax:248-557-8115
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131667163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health