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General NPI Number Information
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NPI Number | 1467442954
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Entity Type | Individual
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Provider Name | CHRISTINE ELAINE THOLEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 331 SIJAN AVE
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City | WHITEMAN AFB
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State | MO
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Zip | 65305
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Country | US
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Telephone | 660-687-6405
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Fax |
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Provider Business Mailing Address
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Address Line | 729 LINDBERGH ST
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City | WHITEMAN AFB
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State | MO
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Zip | 65305-1133
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21900
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License Number State | NE
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