NPI | 1356761498 |
---|---|
Former Name | MARCI LEIGH THAYNE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7714660-4405) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7714660-3102) |
163WG0000X Registered Nurse, General Practice (Licence: UT 7714660-3102) | |
Enumeration Date | 2014-04-16 |
Last Update Date | 2022-12-11 |