Provider Demographics
NPI:1255041703
Name:THIELKE, LESA JO (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:JO
Last Name:THIELKE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S BEHL ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56208-1616
Mailing Address - Country:US
Mailing Address - Phone:320-289-1580
Mailing Address - Fax:
Practice Address - Street 1:30 S BEHL ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:MN
Practice Address - Zip Code:56208-1616
Practice Address - Country:US
Practice Address - Phone:320-289-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily