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Individual

LACIE MICHELLE THEIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP, PMHNP-BC

Contact information

Practice address
111 10TH ST SW, WAVERLY, IA 50677-2925
(319) 352-2329
Mailing address
814 EASTON AVE, WATERLOO, IA 50702-3916
(319) 961-0696

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
G159694
IA

Other

Enumeration date
08/19/2020
Last updated
08/19/2020
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