Provider Demographics
NPI:1306102272
Name:THIEL, ELIZABETH NICOLE (ARNP, CPNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:THIEL
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:NICOLE
Other - Last Name:GREWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7711 E. 111TH ST SUITE 111
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-394-5439
Mailing Address - Fax:
Practice Address - Street 1:7711 E. 111TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-394-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88857363LP0200X
MO2013042564363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics