Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 75680 | WI |
N | 208200000X | Surgeon | 75680 | WI |
N | 208600000X | Surgeon | 75680 | WI |
N | 208200000X | Surgeon | A161353 | CA |
N | 208600000X | Surgeon | A161353 | CA |
NPI | 1467771055 |
---|---|
Provider Name | Carrie Thiessen |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2010 |
Last Update Date | 30/08/2021 |