Provider Demographics
NPI:1902101561
Name:THILL, RICHARD JOHN (RN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:THILL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43188 GUTHRIE RD
Mailing Address - Street 2:
Mailing Address - City:GAYS MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:54631-8266
Mailing Address - Country:US
Mailing Address - Phone:608-872-2295
Mailing Address - Fax:
Practice Address - Street 1:43188 GUTHRIE RD
Practice Address - Street 2:
Practice Address - City:GAYS MILLS
Practice Address - State:WI
Practice Address - Zip Code:54631-8266
Practice Address - Country:US
Practice Address - Phone:608-872-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11604430163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health