Provider Demographics
NPI:1487896015
Name:LECY, MICKY JEAN
Entity type:Individual
Prefix:
First Name:MICKY
Middle Name:JEAN
Last Name:LECY
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 1:508 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55975-1509
Mailing Address - Country:US
Mailing Address - Phone:507-696-1235
Mailing Address - Fax:
Practice Address - Street 1:1450 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-2113
Practice Address - Country:US
Practice Address - Phone:507-696-1235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 184857-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse