Provider Demographics
NPI:1730607599
Name:SPOHN, LACEY DAWN (APRN-C)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:DAWN
Last Name:SPOHN
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12385 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-2192
Mailing Address - Country:US
Mailing Address - Phone:620-926-0040
Mailing Address - Fax:
Practice Address - Street 1:1525 MADISON ST STE 3
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1704
Practice Address - Country:US
Practice Address - Phone:620-378-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5377846112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily