Provider Demographics
NPI:1962037531
Name:WELCH FRALEY, LACEY (RDN)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:
Last Name:WELCH FRALEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MISS
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:300 YARMOUTH ST APT 326
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1249
Mailing Address - Country:US
Mailing Address - Phone:256-508-4129
Mailing Address - Fax:
Practice Address - Street 1:115 COLLEGE PL
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1900
Practice Address - Country:US
Practice Address - Phone:256-508-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered