Individual
MISS STACY MICHELLE LISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP- FNP-C
Contact information
Practice address
101 SE DESTINATION DR, GRIMES, IA 50111-6608
(515) 986-4524
(515) 986-4531
Mailing address
101 SE DESTINATION DR, GRIMES, IA 50111-6608
(515) 986-4524
(515) 986-4531
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A176205
IA
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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