Jandrin, Lacey L

Jandrin, Lacey L is an individual health care provider with primary practice located at 1970 S Ridge Rd , Green Bay WI 54304-4125. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Jandrin, Lacey L can be contacted via phone (920) 430-4888.

Contact Information

Primary practice address
1970 S Ridge Rd Green Bay WI 54304-4125
Phone: (920) 430-4888
Fax: (920) 430-4889
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X 4712 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1135070 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 3761-23 Wisconsin

Profile Details

NPI number 1104183516
LBN Legal business name Jandrin, Lacey L
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 23rd, 2012
Last updated Jan 30th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104183516 NPPES
Other 1135070 NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS

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