Provider Demographics
NPI:1134583024
Name:LACROIX, PRISCILLA SOTH (DO)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:SOTH
Last Name:LACROIX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:SOTH
Other - Last Name:HOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-2155
Practice Address - Street 1:11946 STANDING STONE DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-8094
Practice Address - Country:US
Practice Address - Phone:402-815-4500
Practice Address - Fax:402-815-4510
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE2024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program