Provider Demographics
NPI:1740894799
Name:ZANZIE, LACEY L (NP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:L
Last Name:ZANZIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 S SPRINGFIELD AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-9129
Mailing Address - Country:US
Mailing Address - Phone:417-422-4769
Mailing Address - Fax:
Practice Address - Street 1:3817 S SPRINGFIELD AVE STE 120
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-9129
Practice Address - Country:US
Practice Address - Phone:417-422-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily