Provider Demographics
NPI:1396142253
Name:KUMAR, LACEY JEAN (APNP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:JEAN
Last Name:KUMAR
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:JEAN
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-3522
Practice Address - Country:US
Practice Address - Phone:608-263-6400
Practice Address - Fax:608-262-6743
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6084-33363L00000X
WI6084363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1396142253Medicaid