Provider Demographics
NPI:1134608284
Name:THIEL, AMBER NICHOLE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOLE
Last Name:THIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 MAHOGANY RD
Mailing Address - Street 2:
Mailing Address - City:LYNX
Mailing Address - State:OH
Mailing Address - Zip Code:45650-9721
Mailing Address - Country:US
Mailing Address - Phone:937-544-4389
Mailing Address - Fax:
Practice Address - Street 1:1034 MAHOGANY RD
Practice Address - Street 2:
Practice Address - City:LYNX
Practice Address - State:OH
Practice Address - Zip Code:45650-9721
Practice Address - Country:US
Practice Address - Phone:937-544-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily