Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1497220107 |
---|---|
Provider Name | Linda Thieme |
First Address | Green Bay, WI 54303-2728 |
Second Address | Green Bay, WI 54303-4706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2018 |
Last Update Date | 12/10/2018 |