Provider Demographics
NPI:1275338311
Name:DENNISON, LACY MARIE
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:MARIE
Last Name:DENNISON
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 1:380 ENTERPRISE DR APT 306
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-7908
Mailing Address - Country:US
Mailing Address - Phone:304-678-4484
Mailing Address - Fax:
Practice Address - Street 1:380 ENTERPRISE DR APT 306
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-7908
Practice Address - Country:US
Practice Address - Phone:304-678-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant