Provider Demographics
NPI:1851354955
Name:THIEL, HOLLY F (CRNA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:F
Last Name:THIEL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 E 83RD ST
Mailing Address - Street 2:APT 6C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6140
Mailing Address - Country:US
Mailing Address - Phone:646-752-7969
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:ANESTHESIOLOGY - BOX 1010
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:800-627-4470
Practice Address - Fax:412-937-5767
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY511144-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ62269Medicare UPIN