Provider Demographics
NPI:1477374940
Name:THIERMANN, TODD
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:THIERMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 LINNERUD DR UNIT 71
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1189
Mailing Address - Country:US
Mailing Address - Phone:608-235-7894
Mailing Address - Fax:
Practice Address - Street 1:521 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2721
Practice Address - Country:US
Practice Address - Phone:608-758-1103
Practice Address - Fax:608-758-1208
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0020312310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility