Provider Demographics
NPI:1912417841
Name:SNYDER, LACEY S JANE (APRN)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:S JANE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:S JANE
Other - Last Name:ROESLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2727 S 144TH ST STE 280
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5252
Mailing Address - Country:US
Mailing Address - Phone:402-778-5490
Mailing Address - Fax:402-614-1404
Practice Address - Street 1:2727 S 144TH ST STE 280
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5252
Practice Address - Country:US
Practice Address - Phone:402-778-5490
Practice Address - Fax:402-614-1404
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner