Most Relevant Information
Provider Data
| NPI Number: | 1003076142 |
| Provider Name: | SHANON RENEE LACY D.O. |
| Entity Type: | Individual |
| Taxonomy Code: | 207ZD0900X |
| Specialty: | Pathology |
| License Number: | 56999-21 |
Most Important Dates
| Enumeration Date: | 06/12/2008 |
| Last Updated: | 12/30/2021 |
Provider Practice Location
8901 W LINCOLN AVE
WEST ALLIS
WI
532272409
Practice Location Phone/Fax
| Phone: | 4143287675 |
| Fax: |
Provider Mailing Location
102 N WATER ST UNIT 206
MILWAUKEE
WI
532026056
Provider Mailing Phone/Fax
| Phone: | 3172859918 |
| Fax: |