Provider Demographics
NPI:1255054631
Name:NASSEH, LACY JAY (FNP)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:JAY
Last Name:NASSEH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:JAY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2255 YGNACIO VALLEY RD STE T
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3343
Mailing Address - Country:US
Mailing Address - Phone:925-954-8209
Mailing Address - Fax:925-891-4292
Practice Address - Street 1:2255 YGNACIO VALLEY RD STE T35
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3343
Practice Address - Country:US
Practice Address - Phone:925-681-9246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95120763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily