| NPI | 1821969809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACIE MICHELLE THEIS Np/Owner 319-961-0696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-09-15 |
| Last Update Date | 2025-09-15 |