MEDICARE: KATHERINE THYSSEN DO

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	DO2531	NV

General Provider Information

NPI Number	:	1790191955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE THYSSEN DO

Provider Business Mailing Address
First Line	:	1155 MILL ST # MCM14
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1576
Country	:	US
Telephone Number	:	775-982-5262
Fax Number	:	775-982-5496

Provider Business Practice Location Address
First Line	:	740 DEL MONTE LN STE 3
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-7508
Country	:	US
Telephone Number	:	775-982-5000
Fax Number	:	775-982-3900

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	05/07/2024

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