Provider Demographics
NPI:1306500541
Name:LACEY, GLADYS (LPN)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 QUEEN ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-7019
Mailing Address - Country:US
Mailing Address - Phone:516-263-0366
Mailing Address - Fax:
Practice Address - Street 1:58 QUEEN ELEANOR DR
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-7019
Practice Address - Country:US
Practice Address - Phone:516-263-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP514472279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation