Provider Demographics
NPI:1356599344
Name:LACEK, JULIE (RN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LACEK
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 1:250 WHITE BIRCH LANE
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12842
Mailing Address - Country:US
Mailing Address - Phone:518-648-6141
Mailing Address - Fax:
Practice Address - Street 1:81 WHITE BIRCH LN
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842-1409
Practice Address - Country:US
Practice Address - Phone:518-648-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY418484163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health