Provider Demographics
NPI:1093997421
Name:THIEL, ANN MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:THIEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 BEAL RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8216
Mailing Address - Country:US
Mailing Address - Phone:419-610-7964
Mailing Address - Fax:419-589-4543
Practice Address - Street 1:1591 BEAL RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-8216
Practice Address - Country:US
Practice Address - Phone:419-610-7964
Practice Address - Fax:419-589-4543
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN039026164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse