Individual
JOHN E THIEL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2095 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-5733
(843) 452-7205
Mailing address
2901 MIDDLE ST, SULLIVANS ISLAND, SC 29482-8644
(843) 452-7205
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R58231
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1011
—
SC
Enumeration date
08/15/2005
Last updated
07/08/2007
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