Individual
MS. DARCY THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-3246
Mailing address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-3246
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
R1433265
MN
363LF0000X
Family Nurse Practitioner
Primary
R143326-5
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302795300
—
MN
Enumeration date
05/15/2006
Last updated
03/24/2017
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