Individual
MICAELA T THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP-BC
Contact information
Practice address
HWY 191 AND HOSPITAL DRIVE, CHINLE, AZ 86503
(928) 674-7090
Mailing address
945 E 42ND AVE, SPOKANE, WA 99203-6201
(509) 202-8109
(856) 686-5218
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
AP60577678
WA
363L00000X
Nurse Practitioner
AP60577678
WA
363L00000X
Nurse Practitioner
NP-1523A
ID
363LF0000X
Family Nurse Practitioner
Primary
AP60577678
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2047222
—
WA
Enumeration date
10/08/2012
Last updated
05/16/2024
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