Healthcare Provider Details

I. General information

NPI: 1851128342
Provider Name (Legal Business Name): NATALIE JEAN THIEM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19900 NATIONAL TRAILS HIGHWAY
ORO GRANDE CA
92368
US

IV. Provider business mailing address

12223 SIERRA RD
VICTORVILLE CA
92392-6819
US

V. Phone/Fax

Practice location:
  • Phone: 760-780-7858
  • Fax: 760-513-9770
Mailing address:
  • Phone: 760-963-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number95138577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: