Provider Demographics
NPI:1891944872
Name:THEISEN, CHERYL SUSAN (RN)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:SUSAN
Last Name:THEISEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-9304
Mailing Address - Country:US
Mailing Address - Phone:715-362-2577
Mailing Address - Fax:
Practice Address - Street 1:5621 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-9304
Practice Address - Country:US
Practice Address - Phone:715-362-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI147929-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38323500Medicare UPIN