Provider Demographics
NPI:1033585054
Name:HARTZ, LACEY EDWARDS (NNP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:EDWARDS
Last Name:HARTZ
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:NICOLE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 BLYTHE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5865
Mailing Address - Country:US
Mailing Address - Phone:704-381-4820
Mailing Address - Fax:
Practice Address - Street 1:1001 BLYTHE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5865
Practice Address - Country:US
Practice Address - Phone:704-381-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1033864363LN0000X
MARN2315093363LN0005X
NC5020744363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal