Provider Demographics
NPI:1972872463
Name:BIRDSEYE, LACY C (APRN)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:C
Last Name:BIRDSEYE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6573
Mailing Address - Country:US
Mailing Address - Phone:530-519-5229
Mailing Address - Fax:
Practice Address - Street 1:187 FOREST AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6573
Practice Address - Country:US
Practice Address - Phone:203-255-0695
Practice Address - Fax:203-255-0629
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004853363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health