Provider Demographics
NPI:1043622574
Name:FUCHS, LACE AMBER
Entity type:Individual
Prefix:MRS
First Name:LACE
Middle Name:AMBER
Last Name:FUCHS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LACE
Other - Middle Name:AMBER
Other - Last Name:KUHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 CRANBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-5411
Mailing Address - Country:US
Mailing Address - Phone:631-729-6320
Mailing Address - Fax:
Practice Address - Street 1:118 CRANBERRY DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-5411
Practice Address - Country:US
Practice Address - Phone:631-729-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311782-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse