MEDICARE: MRS. JORDAN L THIERING CD

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	374J00000X	Doula

General Provider Information

NPI Number	:	1023589975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JORDAN L THIERING CD

Provider Business Mailing Address
First Line	:	26 MORGAN ST
Second Line	:
City	:	MILTON
State	:	WI
Zip	:	53563-1237
Country	:	US
Telephone Number	:	608-774-7130
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 MORGAN ST
Second Line	:
City	:	MILTON
State	:	WI
Zip	:	53563-1237
Country	:	US
Telephone Number	:	608-774-7130
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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