Provider Demographics
NPI:1427457597
Name:SCHUCKMAN, LACEY
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:SCHUCKMAN
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 1:4101 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7588
Mailing Address - Country:US
Mailing Address - Phone:785-587-4101
Mailing Address - Fax:785-587-9090
Practice Address - Street 1:4101 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7588
Practice Address - Country:US
Practice Address - Phone:785-587-4101
Practice Address - Fax:785-587-9090
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76477-022363L00000X
KS76477363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care