Provider Demographics
NPI:1508680737
Name:LAPORTE, LACY
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:LAPORTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:
Other - Last Name:BRENNEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:OH
Mailing Address - Zip Code:43543-1135
Mailing Address - Country:US
Mailing Address - Phone:567-239-8187
Mailing Address - Fax:
Practice Address - Street 1:407 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:OH
Practice Address - Zip Code:43543-1135
Practice Address - Country:US
Practice Address - Phone:567-239-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide