Provider Demographics
NPI:1083438725
Name:BOLASH-BEST, LACEY (RN)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:BOLASH-BEST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MESA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-1518
Mailing Address - Country:US
Mailing Address - Phone:217-741-1800
Mailing Address - Fax:
Practice Address - Street 1:39 MESA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1518
Practice Address - Country:US
Practice Address - Phone:217-741-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty