Provider Demographics
NPI:1538578125
Name:HALSRUD, LACY NAOMI (ARNP)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:NAOMI
Last Name:HALSRUD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:WESLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50483-7754
Mailing Address - Country:US
Mailing Address - Phone:641-843-5050
Mailing Address - Fax:641-843-5051
Practice Address - Street 1:103 MAIN ST E
Practice Address - Street 2:
Practice Address - City:WESLEY
Practice Address - State:IA
Practice Address - Zip Code:50483-7754
Practice Address - Country:US
Practice Address - Phone:641-843-5050
Practice Address - Fax:641-843-5051
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA104476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner