Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0031952 | OK |
NPI | 1164450060 |
---|---|
Provider Name | Mrs. Patricia Gregg Lacey |
First Address | Tulsa, OK 74133-5286 |
Second Address | Tulsa, OK 74133-5286 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |