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General NPI Number Information
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NPI Number | 1063503514
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Entity Type | Individual
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Provider Name | LOREN B THIEL MS CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 111 S 5TH ST
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City | DOUGLAS
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State | WY
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Zip | 82633-2434
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Country | US
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Telephone | 307-358-2122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1385
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City | IDAHO FALLS
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State | ID
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Zip | 83403-1385
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Country | US
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Telephone | 208-525-2090
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Fax | 208-523-8978
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 192490704
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License Number State | WY
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