Provider Demographics
NPI:1902320971
Name:LACEFIELD, LEA NICOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:NICOLE
Last Name:LACEFIELD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:NICOLE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10801 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3530
Mailing Address - Country:US
Mailing Address - Phone:240-299-4036
Mailing Address - Fax:
Practice Address - Street 1:9270 GUNSTON RD
Practice Address - Street 2:
Practice Address - City:WELCOME
Practice Address - State:MD
Practice Address - Zip Code:20693-3223
Practice Address - Country:US
Practice Address - Phone:240-299-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily