Provider Demographics
NPI:1851128342
Name:THIEM, NATALIE JEAN (RN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JEAN
Last Name:THIEM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12223 SIERRA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-6819
Mailing Address - Country:US
Mailing Address - Phone:760-963-2940
Mailing Address - Fax:
Practice Address - Street 1:19900 NATIONAL TRAILS HIGHWAY
Practice Address - Street 2:
Practice Address - City:ORO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:92368
Practice Address - Country:US
Practice Address - Phone:760-780-7858
Practice Address - Fax:760-513-9770
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95138577163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty