Provider Demographics
NPI:1902421076
Name:KATOWICH, LACY (FNP)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:KATOWICH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:LACY
Other - Middle Name:L
Other - Last Name:KATOWICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1802 DAY RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-4329
Mailing Address - Country:US
Mailing Address - Phone:572-204-7200
Mailing Address - Fax:
Practice Address - Street 1:1802 DAY RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-4329
Practice Address - Country:US
Practice Address - Phone:574-204-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28151346A163W00000X
INF09201325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse