Provider Demographics
NPI:1801147715
Name:LACY, LANA LYNN (LPN/CFA)
Entity type:Individual
Prefix:MRS
First Name:LANA
Middle Name:LYNN
Last Name:LACY
Suffix:
Gender:F
Credentials:LPN/CFA
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:LYNN
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:233 ST VINCENTS DR BUILDING 3 SUITE 403
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-939-0447
Mailing Address - Fax:
Practice Address - Street 1:833 SAINT VINCENTS DR STE 403
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1614
Practice Address - Country:US
Practice Address - Phone:205-939-0447
Practice Address - Fax:205-939-0418
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP327162164W00000X
AL2-046662164W00000X
TN3788246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No164W00000XNursing Service ProvidersLicensed Practical Nurse