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NPI Code Detail

MEDICARE: MRS. KATHLEEN M. THIEDE MA, RN, FNP-C

MEDICARE: MRS. KATHLEEN M. THIEDE MA, RN, FNP-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
1363L00000XNurse PractitionerR1480412MN

General Provider Information

NPI Number : 1700945086
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHLEEN M. THIEDE MA, RN, FNP-C
Provider Business Mailing Address
First Line : 1200 KENWOOD AVE
Second Line : CSS STUDENT HEALTH SERVICE
City : DULUTH
State : MN
Zip : 55811-4199
Country : US
Telephone Number : 218-723-6282
Fax Number : 218-723-5953
Provider Business Practice Location Address
First Line : 1200 KENWOOD AVE
Second Line : CSS STUDENT HEALTH SERVICE
City : DULUTH
State : MN
Zip : 55811-4199
Country : US
Telephone Number : 218-723-6282
Fax Number : 218-723-5953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 07/08/2007

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