Provider Demographics
NPI:1982885174
Name:THIEL, BRETT J (CRNA)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:J
Last Name:THIEL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6084 COUNTY ROUTE 11
Mailing Address - Street 2:APT. 2
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7729
Mailing Address - Country:US
Mailing Address - Phone:813-541-1331
Mailing Address - Fax:
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY558090163W00000X
NY071102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse