Provider Demographics
NPI:1033436480
Name:LACINA, AMBER JANE (BSN, RN, MSN, APMHNP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JANE
Last Name:LACINA
Suffix:
Gender:F
Credentials:BSN, RN, MSN, APMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 10TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2925
Mailing Address - Country:US
Mailing Address - Phone:319-352-1353
Mailing Address - Fax:319-352-2329
Practice Address - Street 1:111 10TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2925
Practice Address - Country:US
Practice Address - Phone:319-352-1353
Practice Address - Fax:319-352-2329
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123916163WP0808X
IAG-123916363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074435Medicaid