Provider Demographics
NPI:1487984712
Name:THIENPONT, ELIAS DONALD (RN)
Entity type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:DONALD
Last Name:THIENPONT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 3RD AVE W
Mailing Address - Street 2:PO BOX A
Mailing Address - City:RICHARDTON
Mailing Address - State:ND
Mailing Address - Zip Code:58652-7100
Mailing Address - Country:US
Mailing Address - Phone:701-974-3315
Mailing Address - Fax:
Practice Address - Street 1:418 3RD AVE W
Practice Address - Street 2:PO BOX A
Practice Address - City:RICHARDTON
Practice Address - State:ND
Practice Address - Zip Code:58652-7100
Practice Address - Country:US
Practice Address - Phone:701-974-3315
Practice Address - Fax:701-974-3317
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR25022163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse