Provider Demographics
NPI:1164247383
Name:THISSEN, TERESA (OMD, LAC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:THISSEN
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6463 BROOKVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-8320
Mailing Address - Country:US
Mailing Address - Phone:775-815-4241
Mailing Address - Fax:
Practice Address - Street 1:140 W HUFFAKER LN STE 504
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4012
Practice Address - Country:US
Practice Address - Phone:775-815-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2504171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist