Individual
LACEY R VANEMBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
525 BRANSON LANDING BLVD, BRANSON, MO 65616-2052
(417) 239-3392
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R085616
AR
367500000X
Certified Registered Nurse Anesthetist
2018001344
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
CO03204
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910051138
—
MO
Enumeration date
03/08/2017
Last updated
11/15/2024
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