Basic Information
| Provider Information | |||||||||
| NPI: | 1669812665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THUEN | ||||||||
| FirstName: | BOBBI RAE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4535 NORTHERN SKY DR | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585038538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017123000 | ||||||||
| FaxNumber: | 7017123005 | ||||||||
| Practice Location | |||||||||
| Address1: | 4535 NORTHERN SKY DR | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585038538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017123000 | ||||||||
| FaxNumber: | 7017123005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2013 | ||||||||
| LastUpdateDate: | 11/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RL12810 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 12083 | 05 | ND | MEDICAID |