Provider Demographics
NPI:1174683197
Name:THIELE, ROBIN C (RN)
Entity Type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:C
Last Name:THIELE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1761 BROADWAY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2226
Mailing Address - Country:US
Mailing Address - Phone:707-645-2700
Mailing Address - Fax:707-645-2181
Practice Address - Street 1:1761 BROADWAY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2226
Practice Address - Country:US
Practice Address - Phone:707-645-2700
Practice Address - Fax:707-645-2181
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA417888163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management