Provider Demographics
NPI:1053661587
Name:MARABLE, LACIE DAWN (CNM, NP-C)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:DAWN
Last Name:MARABLE
Suffix:
Gender:F
Credentials:CNM, NP-C
Other - Prefix:
Other - First Name:LACIE
Other - Middle Name:DAWN
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, NP-C
Mailing Address - Street 1:5511 VIRGINIA WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7611
Mailing Address - Country:US
Mailing Address - Phone:615-994-1000
Mailing Address - Fax:615-994-0100
Practice Address - Street 1:5511 VIRGINIA WAY
Practice Address - Street 2:STE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7611
Practice Address - Country:US
Practice Address - Phone:615-994-1000
Practice Address - Fax:615-994-0100
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20758363LF0000X, 363L00000X
IL209009802367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife