| NPI | 1609974112 |
|---|---|
| Former Name | VICTORIA ANN THEISEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704150960) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704150960) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-10-03 |