Provider Demographics
NPI:1366069882
Name:HEARRON, LACIE J (RN)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:J
Last Name:HEARRON
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 1:6115 E GREENBLUFF RD
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9525
Mailing Address - Country:US
Mailing Address - Phone:509-939-7269
Mailing Address - Fax:
Practice Address - Street 1:6115 E GREENBLUFF RD
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:WA
Practice Address - Zip Code:99005-9525
Practice Address - Country:US
Practice Address - Phone:509-939-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60071718163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse