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NPI Code Detail

MEDICARE: MICHELLE LYN THEDE PMHNP-BC

MEDICARE: MICHELLE LYN THEDE PMHNP-BC
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
1363L00000XNurse Practitioner17440WI
2363LP0808XPsychiatric/Mental Health Nurse Practitioner17440-33WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255203444
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LYN THEDE PMHNP-BC
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 700 N WESTHAVEN DR
Second Line :
City : OSHKOSH
State : WI
Zip : 54904-6947
Country : US
Telephone Number : 920-303-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2025
Last Update Date : 03/06/2026

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