Provider Demographics
NPI:1356773063
Name:EARLY, LACEY (ND)
Entity type:Individual
Prefix:DR
First Name:LACEY
Middle Name:
Last Name:EARLY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 POND VIEW DR
Mailing Address - Street 2:APT R-305
Mailing Address - City:WOOLWICH TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1869
Mailing Address - Country:US
Mailing Address - Phone:918-370-9279
Mailing Address - Fax:
Practice Address - Street 1:1 POND VIEW DR
Practice Address - Street 2:APT R-305
Practice Address - City:WOOLWICH TWP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1869
Practice Address - Country:US
Practice Address - Phone:918-370-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1948175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath