Provider Demographics
NPI:1174237457
Name:BACALSO, LUCY ANN WONG (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:LUCY ANN
Middle Name:WONG
Last Name:BACALSO
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18611 TUPPER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-1587
Mailing Address - Country:US
Mailing Address - Phone:832-660-5213
Mailing Address - Fax:
Practice Address - Street 1:18611 TUPPER CREEK CT
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-1587
Practice Address - Country:US
Practice Address - Phone:832-660-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXXXXXXX363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care