Provider Demographics
NPI:1457766909
Name:THIEDE, ROBYN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:THIEDE
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 1:2501 CAPEHART ROAD
Mailing Address - Street 2:FAMILY MEDICINE RESIDENCY CLINIC, EHRLING BERGQUIST
Mailing Address - City:OFFUTT AFB
Mailing Address - State:NE
Mailing Address - Zip Code:68113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 CAPEHART ROAD
Practice Address - Street 2:FAMILY MEDICINE RESIDENCY CLINIC, EHRLING BERGQUIST
Practice Address - City:OFFUTT AFB
Practice Address - State:NE
Practice Address - Zip Code:68113
Practice Address - Country:US
Practice Address - Phone:402-232-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1920363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care