Healthcare Provider Details

I. General information

NPI: 1174992408
Provider Name (Legal Business Name): RHIANNON THAI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CARVER RD
PLYMOUTH MA
02360-5207
US

IV. Provider business mailing address

176 CARVER RD
PLYMOUTH MA
02360-5207
US

V. Phone/Fax

Practice location:
  • Phone: 508-209-8447
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN283877
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN283877
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: