MEDICARE: MARI KATHERINE THIEDE MSN, BSN, RN

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
1	163W00000X	Registered Nurse	4704315444	MI

General Provider Information

NPI Number	:	1720760085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARI KATHERINE THIEDE MSN, BSN, RN

Provider Business Mailing Address
First Line	:	1488 WHITE SANDS RD
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-5300
Country	:	US
Telephone Number	:	734-740-2640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1488 WHITE SANDS RD
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-5300
Country	:	US
Telephone Number	:	734-740-2640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	08/04/2023

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