Individual
LAUREN PATRICIA DIVINE-THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-BC
Contact information
Practice address
400 CAMBRIDGE ST, KANSAS CITY, KS 66160-0001
(913) 588-1227
Mailing address
400 CAMBRIDGE ST, KANSAS CITY, KS 66160-0001
(913) 588-1227
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
53-78288-102
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53-78288-102
KANSAS STATE BOARD OF NURSING NURSE PRACTITIONER LICENSE
KS
Enumeration date
08/14/2018
Last updated
08/14/2018
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