Individual
CRYSTAL THIEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2595 HAVEN RD, GREEN BAY, WI 54313-6830
(920) 419-8184
Mailing address
2595 HAVEN RD, GREEN BAY, WI 54313-6830
(920) 419-8184
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
221637-30
WI
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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