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General NPI Number Information
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NPI Number | 1760365829
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Entity Type | Individual
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Provider Name | MELISSA THIELE
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Gender | Female
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 6201 HARRY HINES BLVD
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City | DALLAS
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State | TX
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Zip | 75235-5202
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Country | US
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Telephone | 214-633-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 CLIBURN DR
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City | FORT WORTH
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State | TX
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Zip | 76244-6129
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1010453
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License Number State | TX
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