Provider Demographics
NPI:1851831499
Name:CHEESEMAN, LACEY RAE (ARNP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:RAE
Last Name:CHEESEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:RAE
Other - Last Name:COQUELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 NW BOULDER BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8725
Mailing Address - Country:US
Mailing Address - Phone:515-423-7533
Mailing Address - Fax:
Practice Address - Street 1:3200 GRAND AVE # 6
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4104
Practice Address - Country:US
Practice Address - Phone:515-244-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA109462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily