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NPI Code Detail

MEDICARE: CARLY THINER NP-C

MEDICARE: CARLY THINER NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner3091MN

General Provider Information

NPI Number : 1629400163
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY THINER NP-C
Provider Business Mailing Address
First Line : 17489 DODD BLVD
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-6506
Country : US
Telephone Number : 952-429-1020
Fax Number :
Provider Business Practice Location Address
First Line : 17489 DODD BLVD
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-6506
Country : US
Telephone Number : 952-428-1020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2013
Last Update Date : 02/02/2026

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