Provider Demographics
NPI:1093520504
Name:FISHER, LACEY ROSE
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:ROSE
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 CRESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2793
Mailing Address - Country:US
Mailing Address - Phone:831-587-3555
Mailing Address - Fax:
Practice Address - Street 1:1205 FREEDOM BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2777
Practice Address - Country:US
Practice Address - Phone:559-287-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty