1720760085 NPI number — MARI KATHERINE THIEDE MSN, BSN, RN

Table of content: MARI KATHERINE THIEDE MSN, BSN, RN (NPI 1720760085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720760085 NPI number — MARI KATHERINE THIEDE MSN, BSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIEDE
Provider First Name:
MARI
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, BSN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLAY
Provider Other First Name:
MARI
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720760085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1488 WHITE SANDS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37743-5300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-740-2640
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1488 WHITE SANDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37743-5300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-740-2640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  4704315444 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com