Provider Demographics
NPI:1811776677
Name:KNEIPP, LACIE SHAWN
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:SHAWN
Last Name:KNEIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-1137
Mailing Address - Country:US
Mailing Address - Phone:513-780-9227
Mailing Address - Fax:
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-1137
Practice Address - Country:US
Practice Address - Phone:513-780-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker