Healthcare Provider Details

I. General information

NPI: 1487866570
Provider Name (Legal Business Name): MOLLY E.W. THIESSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY E WELCH MD

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4949
  • Fax: 303-602-5184
Mailing address:
  • Phone: 303-436-4949
  • Fax: 303-602-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1722
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0046574
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: