Provider Demographics
NPI:1043399280
Name:THIELEKE, CHERI LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHERI
Middle Name:LYNN
Last Name:THIELEKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CHERI
Other - Middle Name:LYNN
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5745
Mailing Address - Country:US
Mailing Address - Phone:515-239-2155
Mailing Address - Fax:515-239-2050
Practice Address - Street 1:1111 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5745
Practice Address - Country:US
Practice Address - Phone:515-239-2155
Practice Address - Fax:515-239-2050
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant