Provider Demographics
NPI:1902344914
Name:NEAL, LACY (LPN)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5737 SE HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5526
Mailing Address - Country:US
Mailing Address - Phone:815-531-9061
Mailing Address - Fax:
Practice Address - Street 1:5737 SE HAROLD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-5526
Practice Address - Country:US
Practice Address - Phone:815-531-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201604044LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse