Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | G-123916 | IA |
NPI | 1033436480 |
---|---|
Provider Name | Ms. Amber Jane Lacina |
First Address | Waverly, IA 50677-2925 |
Second Address | Waverly, IA 50677-2925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 29/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0074435 | (05) | IA |