Provider Demographics
NPI:1023743903
Name:THEIS, LAURA HELEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:HELEN
Last Name:THEIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MANCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4540
Mailing Address - Country:US
Mailing Address - Phone:512-589-4696
Mailing Address - Fax:
Practice Address - Street 1:164 BELTERRA VILLAGE WAY STE Y200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-4804
Practice Address - Country:US
Practice Address - Phone:512-866-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily