Provider Demographics
NPI:1184912503
Name:PARKER, LACEY (APRN)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:PARKER
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 1:33 PICCADILLY WAY
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2207
Mailing Address - Country:US
Mailing Address - Phone:857-272-3030
Mailing Address - Fax:
Practice Address - Street 1:414 UNION ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-2154
Practice Address - Country:US
Practice Address - Phone:508-881-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4700363LF0000X
MARN2268153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily