Provider Demographics
NPI:1922049048
Name:THEISS, NICHOLEE RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLEE
Middle Name:RUTH
Last Name:THEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 GRAHAM CIR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-3617
Mailing Address - Country:US
Mailing Address - Phone:720-253-5938
Mailing Address - Fax:
Practice Address - Street 1:1396 GRAHAM CIR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-3617
Practice Address - Country:US
Practice Address - Phone:720-253-5938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46035-020207Q00000X
CO46301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84126531Medicaid
COCO300680Medicare PIN
I39439Medicare UPIN
AZI39439Medicare UPIN
I39439Medicare UPIN