Provider Demographics
NPI:1629066022
Name:THIEL, JANE BROOKE (WHNP, BC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:BROOKE
Last Name:THIEL
Suffix:
Gender:F
Credentials:WHNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MIDTOWNE STREET NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5731
Mailing Address - Country:US
Mailing Address - Phone:616-588-1200
Mailing Address - Fax:616-588-1250
Practice Address - Street 1:555 MIDTOWNE STREET NE
Practice Address - Street 2:SUITE 400
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5731
Practice Address - Country:US
Practice Address - Phone:616-588-1200
Practice Address - Fax:616-588-1250
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704083485363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner