Provider Demographics
NPI:1417758145
Name:LACY, NICOLE CATHRYN (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CATHRYN
Last Name:LACY
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:CATHRYN
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5227 AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-8549
Mailing Address - Country:US
Mailing Address - Phone:406-565-2746
Mailing Address - Fax:
Practice Address - Street 1:1233 N 30TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0127
Practice Address - Country:US
Practice Address - Phone:406-237-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT103963163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse