Healthcare Provider Details

I. General information

NPI: 1518975606
Provider Name (Legal Business Name): MICHAEL THOMAS LIEN M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 E DIVISION ST
RIVER FALLS WI
54022-1571
US

IV. Provider business mailing address

371 MILWAUKEE RD
HUDSON WI
54016-8130
US

V. Phone/Fax

Practice location:
  • Phone: 715-426-6155
  • Fax:
Mailing address:
  • Phone: 715-781-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number145236-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: