Provider Demographics
NPI:1942575048
Name:WEST, LACEY DIANE (LPN)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:DIANE
Last Name:WEST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4996 WESTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-3143
Mailing Address - Country:US
Mailing Address - Phone:315-825-5708
Mailing Address - Fax:
Practice Address - Street 1:4996 WESTVILLE RD
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-3143
Practice Address - Country:US
Practice Address - Phone:315-825-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274104164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse