Provider Demographics
NPI:1902279144
Name:TAYLOR, LACEY TRINETTE (RN)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:TRINETTE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6184 BABIN WILSON ST.
Mailing Address - Street 2:
Mailing Address - City:CONVENT
Mailing Address - State:LA
Mailing Address - Zip Code:70723
Mailing Address - Country:US
Mailing Address - Phone:225-206-4635
Mailing Address - Fax:
Practice Address - Street 1:6184 BABIN WILSON ST.
Practice Address - Street 2:
Practice Address - City:CONVENT
Practice Address - State:LA
Practice Address - Zip Code:70723
Practice Address - Country:US
Practice Address - Phone:225-206-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA114112163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse