Individual
LACEY JO MYERS I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1325 NE 31ST ST, ANKENY, IA 50021-6695
(515) 279-1959
(515) 289-0888
Mailing address
2213 GRAND AVE, DES MOINES, IA 50312-5305
(515) 237-3974
(515) 883-2692
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A128569
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I43700006
MEDICARE PTAN MMP
IA
01
—
IB3557001
MEDICARE PTAN TEAMMD
IA
Enumeration date
11/05/2015
Last updated
07/11/2016
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