Provider Demographics
NPI:1396490520
Name:ST. CYR, MICHELLE-LACY (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE-LACY
Middle Name:
Last Name:ST. CYR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GROSVENOR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1618
Mailing Address - Country:US
Mailing Address - Phone:978-912-0580
Mailing Address - Fax:
Practice Address - Street 1:15 GROSVENOR AVE
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1618
Practice Address - Country:US
Practice Address - Phone:978-912-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH018461-22164W00000X
MA172V00000X
MALN94846164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No172V00000XOther Service ProvidersCommunity Health Worker