Provider Demographics
NPI:1861127730
Name:MCGREE, LACEY ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:ELAINE
Last Name:MCGREE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 LEGEND LOOP APT F103
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8658
Mailing Address - Country:US
Mailing Address - Phone:406-565-3529
Mailing Address - Fax:406-457-4110
Practice Address - Street 1:2442 WINNE AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4921
Practice Address - Country:US
Practice Address - Phone:406-457-4100
Practice Address - Fax:406-457-4110
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT129305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program