Provider Demographics
NPI:1295593226
Name:DRISCOL, LACIE (MSN APRN CNM)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:
Last Name:DRISCOL
Suffix:
Gender:
Credentials:MSN APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 PARKRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8693
Mailing Address - Country:US
Mailing Address - Phone:815-347-4233
Mailing Address - Fax:
Practice Address - Street 1:1391 PARKRIDGE CT
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8693
Practice Address - Country:US
Practice Address - Phone:815-347-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041438089163WP1700X
IL209.032003367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WP1700XNursing Service ProvidersRegistered NursePerinatal