Basic Information
| Provider Information | |||||||||
| NPI: | 1720251077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LACY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033012588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032249661 | ||||||||
| FaxNumber: | 6032287051 | ||||||||
| Practice Location | |||||||||
| Address1: | 246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033012588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032249661 | ||||||||
| FaxNumber: | 6032287051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2008 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 15384 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RS0012X | 15384 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RP1001X | 15384 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.