Provider Demographics
NPI:1265583710
Name:THIEL, SHELBA JEAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHELBA
Middle Name:JEAN
Last Name:THIEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:THIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1394 ABBIE KILGORE WAY
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7580
Mailing Address - Country:US
Mailing Address - Phone:770-985-0498
Mailing Address - Fax:
Practice Address - Street 1:1394 ABBIE KILGORE WAY
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-7580
Practice Address - Country:US
Practice Address - Phone:770-985-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN076354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily