| NPI | 1124214895 |
|---|---|
| Other Name | MARY ELIZABETH THELAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5018499) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: SC 3357) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2024-02-05 |