Provider Demographics
NPI:1316941826
Name:THIEM, LAURA J (RN, FNP-BC, CNS-BC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:J
Last Name:THIEM
Suffix:
Gender:F
Credentials:RN, FNP-BC, CNS-BC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:CHIPMAN-THIEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, FNP-BC, CNS-BC
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MO
Mailing Address - Zip Code:64720-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 EAST MAIN
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MO
Practice Address - Zip Code:64720
Practice Address - Country:US
Practice Address - Phone:816-297-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO138659363LF0000X, 364SP0809X
KS44662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
S28359Medicare UPIN