Provider Demographics
NPI:1831852037
Name:THIELE, MARY HANNAH (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:HANNAH
Last Name:THIELE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:HANNAH
Other - Last Name:BOLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:
Practice Address - Street 1:410 42ND AVE N STE 400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3658
Practice Address - Country:US
Practice Address - Phone:615-329-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily