Provider Demographics
NPI:1336879253
Name:LACY, TANESHIA (RN)
Entity Type:Individual
Prefix:
First Name:TANESHIA
Middle Name:
Last Name:LACY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 GLEN MOHR CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-2888
Mailing Address - Country:US
Mailing Address - Phone:302-463-9883
Mailing Address - Fax:
Practice Address - Street 1:1209 GLEN MOHR CT
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-2888
Practice Address - Country:US
Practice Address - Phone:302-463-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0036975163WI0500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy