Provider Demographics
NPI:1811717267
Name:LACEY, REGINA ANN (RN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:LACEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:REGINA
Other - Middle Name:ANN
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4039 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7047
Mailing Address - Country:US
Mailing Address - Phone:216-407-0624
Mailing Address - Fax:
Practice Address - Street 1:4039 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44122-7047
Practice Address - Country:US
Practice Address - Phone:216-407-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.379676163WS0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool