Individual
LACEY UPHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
618 N BENTON AVE, SPRINGFIELD, MO 65806-1102
(417) 831-0150
(417) 865-3479
Mailing address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 831-0150
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2024040275
MO
Other
Enumeration date
10/03/2024
Last updated
03/25/2025
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