Most Relevant Information
Provider Data
| NPI Number: | 1003658964 |
| Provider Name: | ETHAN WILLIAM GARYSON THIES APN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 26NJ14996900 |
Most Important Dates
| Enumeration Date: | 06/11/2024 |
| Last Updated: | 06/11/2024 |
Provider Practice Location
401 KINGS HWY S
CHERRY HILL
NJ
080342500
Practice Location Phone/Fax
| Phone: | 8562090447 |
| Fax: |
Provider Mailing Location
249 THIES RD
SEWELL
NJ
080802046
Provider Mailing Phone/Fax
| Phone: | 8566936459 |
| Fax: |