Provider Demographics
NPI:1962863183
Name:THYGESEN, ALICE MARIE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:MARIE
Last Name:THYGESEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NA
Mailing Address - Street 1:7778 CURRY RD
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-9298
Mailing Address - Country:US
Mailing Address - Phone:775-423-9836
Mailing Address - Fax:
Practice Address - Street 1:7778 CURRY RD
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-9298
Practice Address - Country:US
Practice Address - Phone:775-423-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN219336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health