Individual
SAMANTHA L THIEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
608 W BROWN ST, WAUPUN, WI 53963-1788
(920) 324-6801
Mailing address
608 W BROWN ST, WAUPUN, WI 53963-1788
(920) 324-6801
(920) 324-8439
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10152
WI
Other
Enumeration date
07/20/2020
Last updated
05/04/2022
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