Provider Demographics
NPI:1720172927
Name:THIEL, SHARON W (APNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:W
Last Name:THIEL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N17 W24100 RIVERWOOD DR
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-2570
Practice Address - Fax:262-928-5194
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2433-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41199200Medicaid
WI41199200Medicaid
WI003368280Medicare PIN
WIQ23597Medicare UPIN