Provider Demographics
NPI:1811953797
Name:THIEL, CLINTON A (RN, MSN, MN)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:A
Last Name:THIEL
Suffix:
Gender:M
Credentials:RN, MSN, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 BARNES BLVD
Mailing Address - Street 2:
Mailing Address - City:MCCHORD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:98332
Mailing Address - Country:US
Mailing Address - Phone:253-982-5165
Mailing Address - Fax:253-982-8406
Practice Address - Street 1:690 BARNES BOULEVARD
Practice Address - Street 2:
Practice Address - City:MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98332
Practice Address - Country:US
Practice Address - Phone:253-982-5165
Practice Address - Fax:253-982-8406
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00086503163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse