Healthcare Provider Details

I. General information

NPI: 1043399280
Provider Name (Legal Business Name): CHERI LYNN THIELEKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHERI LYNN MEYER

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DUFF AVE
AMES IA
50010-5745
US

IV. Provider business mailing address

1111 DUFF AVE
AMES IA
50010-5745
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-2155
  • Fax: 515-239-2050
Mailing address:
  • Phone: 515-239-2155
  • Fax: 515-239-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001113
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: