Provider Demographics
NPI:1710734058
Name:HAAS, LACEY NICOLE
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:NICOLE
Last Name:HAAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-1508
Mailing Address - Country:US
Mailing Address - Phone:419-261-0636
Mailing Address - Fax:
Practice Address - Street 1:86 ALPINE DR
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-1508
Practice Address - Country:US
Practice Address - Phone:419-261-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty