Basic Information
| Provider Information | |||||||||
| NPI: | 1740890748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KYRISS | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7501 TERRY DR | ||||||||
| Address2: | |||||||||
| City: | LA VISTA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681282564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4029805260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1021 NEBRASKA ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511051436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122522477 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2020 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | B160105 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.