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NPI Code Detail

MEDICARE: SAMANTHA L THIEDE APNP

MEDICARE: SAMANTHA L THIEDE APNP
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 Practitioner10152WI

General Provider Information

NPI Number : 1306454053
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA L THIEDE APNP
Provider Business Mailing Address
First Line : 608 W BROWN ST
Second Line :
City : WAUPUN
State : WI
Zip : 53963-1788
Country : US
Telephone Number : 920-324-6801
Fax Number : 920-324-8439
Provider Business Practice Location Address
First Line : 608 W BROWN ST
Second Line :
City : WAUPUN
State : WI
Zip : 53963-1788
Country : US
Telephone Number : 920-324-6801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2020
Last Update Date : 05/04/2022

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Directions to “ SAMANTHA L THIEDE APNP” Practice Location

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