Individual
LACIE DIANA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
400 E POLK ST, WASHINGTON, IA 52353-1237
(720) 299-1721
Mailing address
729 S 10TH AVE, WASHINGTON, IA 52353-1303
(172) 029-9172
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A177192
IA
Other
Enumeration date
12/04/2023
Last updated
12/07/2023
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