Provider Demographics
NPI:1255990479
Name:LANGLEY, LACEY C (RN)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:C
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:C
Other - Last Name:BRAZILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3510 STEELHAMMER DR
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4551
Mailing Address - Country:US
Mailing Address - Phone:360-632-8020
Mailing Address - Fax:
Practice Address - Street 1:3510 STEELHAMMER DR
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4551
Practice Address - Country:US
Practice Address - Phone:360-623-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60945996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse