Healthcare Provider Details

I. General information

NPI: 1225072580
Provider Name (Legal Business Name): DEBRA WELLS THAYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 IRVING ST NW # 4131
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

6525 BELCREST RD SUITE 700
HYATTSVILLE MD
20782-2003
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8946
  • Fax: 202-877-6775
Mailing address:
  • Phone: 301-560-2944
  • Fax: 301-560-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAC000217
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024071247
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN43659
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: