Provider Demographics
NPI:1376356600
Name:LACY, DEBORAH (RN, MS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LACY
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 TAMSIN CT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3752
Mailing Address - Country:US
Mailing Address - Phone:443-956-5465
Mailing Address - Fax:
Practice Address - Street 1:2801 HEMLOCK AVE FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1246
Practice Address - Country:US
Practice Address - Phone:410-323-5002
Practice Address - Fax:410-323-5001
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse