Lacy Jae Wade
Individual provider Active NPI Licensed Vocational Nurse · Diboll, TX
NPI 1669972360 · NPPES record last updated Feb 19, 2018
Key facts
- NPI
- 1669972360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Vocational Nurse 164X00000X
- License
- 233648 (TX)
- Practice address
- 3457 FM 819
Diboll, TX 75941-4707 - Phone
- (936) 239-6055
- NPI assigned
- Feb 19, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 233648 | TX | MD | Licensed Vocational Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 233648 | TX | Yes |
Addresses
Primary practice location
3457 FM 819
Diboll, TX 75941-4707
Mailing address
3457 FM 819
Diboll, TX 75941-4707
Other providers in Diboll, TX
- Perlita Gicaro Tarongoy
- Marilyn Thompson
- Katlyn Townsend
- Trinity Mission of Diboll, LLC
- Trinity Nursing and Rehabilitation of Diboll, LP
All providers in Diboll, TX · Licensed Vocational Nurse in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.