Provider Demographics
NPI:1366469074
Name:THEISEN, APRIL A (PA-C)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:A
Last Name:THEISEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:THEISEN
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3265 HILLCREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7657
Mailing Address - Country:US
Mailing Address - Phone:541-210-8721
Mailing Address - Fax:
Practice Address - Street 1:1325 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1358
Practice Address - Country:US
Practice Address - Phone:541-460-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51464363A00000X
ORPA10004813363A00000X
ORPA198758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0195994OtherLABOR & INDUSTRY
CA1366469074OtherMEDICAL
WA8428922Medicaid
CA1366469074OtherMEDICAL
WA0195994OtherLABOR & INDUSTRY