Individual
MRS. KELLIE R THIESSEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CNM,MS
Contact information
Practice address
1201 E. HWY 18, PINE RIDGE, SD 57770
(605) 867-3003
Mailing address
PO BOX 3055, PINE RIDGE, SD 57770-3055
(605) 867-2052
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036
CERTIFIED NURSE MIDWIFE
SD
Enumeration date
02/08/2006
Last updated
07/08/2007
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