Provider Demographics
NPI:1700945086
Name:THIEDE, KATHLEEN M (MA, RN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:THIEDE
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Gender:F
Credentials:MA, RN, FNP-C
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Mailing Address - Street 1:1200 KENWOOD AVE
Mailing Address - Street 2:CSS STUDENT HEALTH SERVICE
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4199
Mailing Address - Country:US
Mailing Address - Phone:218-723-6282
Mailing Address - Fax:218-723-5953
Practice Address - Street 1:1200 KENWOOD AVE
Practice Address - Street 2:CSS STUDENT HEALTH SERVICE
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4199
Practice Address - Country:US
Practice Address - Phone:218-723-6282
Practice Address - Fax:218-723-5953
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MNR1480412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner