Provider Demographics
NPI:1346222783
Name:THIEN, LESLIE W (CRNA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:W
Last Name:THIEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13523 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-3802
Mailing Address - Country:US
Mailing Address - Phone:314-775-2816
Mailing Address - Fax:314-775-2821
Practice Address - Street 1:10448 OLD OLIVE STREET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5924
Practice Address - Country:US
Practice Address - Phone:314-743-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO080623367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO915233126Medicaid
MOP00307916OtherRR MEDICARE
MOP00307916OtherRR MEDICARE