Individual
CORBY LOUISE THIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1116 N 16TH ST, LAFAYETTE, IN 47904-2119
(765) 428-5850
(765) 428-5851
Mailing address
1040 SIERRA DR STE 400, GREENWOOD, IN 46143-7241
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001362A
IN
363LP2300X
Primary Care Nurse Practitioner
71001362A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000300074
ANTHEM PROVIDER NUMBER
IN
05
—
200388070
—
IN
01
—
9397705
PHCS PID NUMBER
IN
Enumeration date
03/14/2006
Last updated
03/12/2021
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