Basic Information
| Provider Information | |||||||||
| NPI: | 1740760305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIVINE-THIELE | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | PATRICIA | ||||||||
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| Credential: | APRN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135881227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135881227 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 53-78288-102 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 53-78288-102 | 01 | KS | KANSAS STATE BOARD OF NURSING NURSE PRACTITIONER LICENSE | OTHER | 53-78288-102 | 01 | KS | KANSAS REGISTERED NURSE LICENSE | OTHER |