Healthcare Provider Details

I. General information

NPI: 1164241154
Provider Name (Legal Business Name): LISA THAYER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 N TRUCKEE LN
SPARKS NV
89434-1570
US

IV. Provider business mailing address

3300 N TRUCKEE LN
SPARKS NV
89434-1570
US

V. Phone/Fax

Practice location:
  • Phone: 775-742-7697
  • Fax:
Mailing address:
  • Phone: 775-742-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number881554
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: