| NPI | 1467853424 |
|---|---|
| Former Name | KELLI SUE THIESEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NE 111712) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NE 111712) |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A138823) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2019-08-29 |