Individual
MS. MARIA L THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1200
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008000261F
HUMANA
—
05
—
1962458158
—
WI
Enumeration date
05/26/2006
Last updated
10/09/2014
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