Healthcare Provider Details

I. General information

NPI: 1760866974
Provider Name (Legal Business Name): CYNTHIA MARIE THIEM FNP-BC, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 E 22ND ST
TUCSON AZ
85710-6427
US

IV. Provider business mailing address

7350 E 22ND ST
TUCSON AZ
85710-6427
US

V. Phone/Fax

Practice location:
  • Phone: 520-717-8389
  • Fax: 520-771-9339
Mailing address:
  • Phone: 520-771-8389
  • Fax: 520-771-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9575
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberAP9575
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: