Provider Demographics
NPI:1639811078
Name:THIEMAN, TAYLOR KAY
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KAY
Last Name:THIEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:KAY
Other - Last Name:UHLIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10847 SUNRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136
Mailing Address - Country:US
Mailing Address - Phone:402-841-8441
Mailing Address - Fax:
Practice Address - Street 1:985645 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1554
Practice Address - Country:US
Practice Address - Phone:402-552-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE9561207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program