Provider Demographics
NPI:1306089214
Name:FISHER, LACEY BOND (APRN)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:BOND
Last Name:FISHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:BOND
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4856 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5539
Mailing Address - Country:US
Mailing Address - Phone:970-494-4200
Mailing Address - Fax:970-613-4475
Practice Address - Street 1:323 E 27TH ST STE A&B
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3203
Practice Address - Country:US
Practice Address - Phone:970-310-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1000503-NP363LP0808X
MT100452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMM1950484OtherDEA REGISTRATION NUMBER
MT0000373111OtherBLUE CROSS-SHIELD PROVIDER NUMBER
MT011002625Medicare PIN