Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 382380 | NY |
NPI | 1023397775 |
---|---|
Provider Name | Lacey Rae Fox-Smith |
First Address | Dansville, NY 14437-9502 |
Second Address | Dansville, NY 14437-9502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2011 |
Last Update Date | 29/11/2016 |