Provider Demographics
NPI:1720760085
Name:THIEDE, MARI KATHERINE (MSN, BSN, RN)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:KATHERINE
Last Name:THIEDE
Suffix:
Gender:F
Credentials:MSN, BSN, RN
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:KATHERINE
Other - Last Name:CLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1488 WHITE SANDS RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-5300
Mailing Address - Country:US
Mailing Address - Phone:734-740-2640
Mailing Address - Fax:
Practice Address - Street 1:1488 WHITE SANDS RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-5300
Practice Address - Country:US
Practice Address - Phone:734-740-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704315444163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse