Basic Information
| Provider Information | |||||||||
| NPI: | 1619488905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIELEMAN | ||||||||
| FirstName: | CHLOE | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2826 HARRIS ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955034809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074438066 | ||||||||
| FaxNumber: | 7072683251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2826 HARRIS ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955034809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074438066 | ||||||||
| FaxNumber: | 7072683251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2017 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA059152 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA56260 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.