| NPI | 1235691668 |
|---|---|
| Former Name | BRITNEY RAE THACKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024177431) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 0000025694) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2019-04-04 |