1801309661 NPI number — MRS. AYLEE MARIE THIERFELDER LAC.

Table of content: MRS. AYLEE MARIE THIERFELDER LAC. (NPI 1801309661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801309661 NPI number — MRS. AYLEE MARIE THIERFELDER LAC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIERFELDER
Provider First Name:
AYLEE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LAC.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCFADDEN
Provider Other First Name:
AYLEE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801309661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 3RD ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEFISH
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59937-3116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-249-3692
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 2ND ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEFISH
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59937-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-863-6001
Provider Business Practice Location Address Fax Number:
406-451-0333
Provider Enumeration Date:
11/14/2017

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: 171100000X , with the licence number:  MED-ACU-LIC-78512 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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