Provider Demographics
NPI:1043056864
Name:LACY, JAMIE LOUISE (BS, LC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LOUISE
Last Name:LACY
Suffix:
Gender:F
Credentials:BS, LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 ABBEY WAY
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1734
Mailing Address - Country:US
Mailing Address - Phone:952-992-9005
Mailing Address - Fax:
Practice Address - Street 1:8901 AZTEC DR STE B
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1916
Practice Address - Country:US
Practice Address - Phone:678-509-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN