Basic Information
| Provider Information | |||||||||
| NPI: | 1093139552 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIERS | ||||||||
| FirstName: | SEAN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5015 MANCHESTER CT | ||||||||
| Address2: | |||||||||
| City: | GRANITE BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957467185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083756967 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 SISTER MARY COLUMBA DR | ||||||||
| Address2: | |||||||||
| City: | RED BLUFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960804327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305298000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2014 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 95000070 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.