Provider Demographics
NPI:1881316065
Name:WILLIAMS, LACY (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WINTERGREEN TRL
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9072
Mailing Address - Country:US
Mailing Address - Phone:906-362-3701
Mailing Address - Fax:
Practice Address - Street 1:545 COUNTY ROAD HQ
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8855
Practice Address - Country:US
Practice Address - Phone:906-273-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily