Provider Demographics
NPI:1952592701
Name:LACEY, ANNE LORETTA (APRN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LORETTA
Last Name:LACEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-1843
Mailing Address - Country:US
Mailing Address - Phone:603-659-3106
Mailing Address - Fax:603-659-8003
Practice Address - Street 1:207 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMARKET
Practice Address - State:NH
Practice Address - Zip Code:03857-1843
Practice Address - Country:US
Practice Address - Phone:603-659-3106
Practice Address - Fax:603-659-8003
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH033239-23363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011426Medicaid
NH30011426Medicaid
NP1905Medicare PIN