Provider Demographics
NPI:1255140299
Name:THEISEN, LAURA MARIE
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:THEISEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72960 613 AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:NE
Mailing Address - Zip Code:68443-6025
Mailing Address - Country:US
Mailing Address - Phone:402-335-8320
Mailing Address - Fax:
Practice Address - Street 1:61005 732 RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:NE
Practice Address - Zip Code:68443-8650
Practice Address - Country:US
Practice Address - Phone:402-866-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion