MEDICARE: LAURA HELEN THEIS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1087030	TX

General Provider Information

NPI Number	:	1023743903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HELEN THEIS FNP-BC

Provider Business Mailing Address
First Line	:	260 MANCHESTER LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-4540
Country	:	US
Telephone Number	:	512-589-4696
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 BELTERRA VILLAGE WAY STE Y200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-4804
Country	:	US
Telephone Number	:	512-866-3016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2022
Last Update Date	:	07/23/2022

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