Individual
MALLORY MARGARET THIELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6520 FULLERTON CT, JOHNSTON, IA 50131-3012
(515) 745-1887
Mailing address
6520 FULLERTON CT, JOHNSTON, IA 50131-3012
(515) 745-1887
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
IA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
IA
Other
Enumeration date
06/04/2021
Last updated
06/04/2021
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