Provider Demographics
NPI:1356996482
Name:MANSFIELD, LACY R (CPM)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:R
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 E COLE ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-8953
Mailing Address - Country:US
Mailing Address - Phone:307-331-7430
Mailing Address - Fax:
Practice Address - Street 1:754 E COLE ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-8953
Practice Address - Country:US
Practice Address - Phone:307-331-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife