Healthcare Provider Details

I. General information

NPI: 1164344974
Provider Name (Legal Business Name): HEATHER MARIE THAYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 FINN ST S
SAINT PAUL MN
55105-1012
US

IV. Provider business mailing address

990 CHATSWORTH PL
SHOREVIEW MN
55126-2259
US

V. Phone/Fax

Practice location:
  • Phone: 651-962-6750
  • Fax:
Mailing address:
  • Phone: 507-429-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14519
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: