Provider Demographics
NPI:1972821114
Name:CURTIS, LACEASA LANETT (RN)
Entity type:Individual
Prefix:MISS
First Name:LACEASA
Middle Name:LANETT
Last Name:CURTIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 N CAMBRIDGE AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1733
Mailing Address - Country:US
Mailing Address - Phone:414-807-9125
Mailing Address - Fax:
Practice Address - Street 1:1855 N CAMBRIDGE AVE APT 106
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1733
Practice Address - Country:US
Practice Address - Phone:414-807-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI168056-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse