Provider Demographics
NPI:1760866974
Name:THIEM, CYNTHIA MARIE (FNP-BC, MSN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:THIEM
Suffix:
Gender:F
Credentials:FNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6427
Mailing Address - Country:US
Mailing Address - Phone:520-771-8389
Mailing Address - Fax:520-771-9339
Practice Address - Street 1:7350 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6427
Practice Address - Country:US
Practice Address - Phone:520-717-8389
Practice Address - Fax:520-771-9339
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9575363LF0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ373008Medicaid