Provider Demographics
NPI:1518579473
Name:THIELE, SOLEIL (RD)
Entity Type:Individual
Prefix:
First Name:SOLEIL
Middle Name:
Last Name:THIELE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 N BROADWAY DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9316
Mailing Address - Country:US
Mailing Address - Phone:530-545-8622
Mailing Address - Fax:
Practice Address - Street 1:2210 N BROADWAY DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9316
Practice Address - Country:US
Practice Address - Phone:530-545-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered