Healthcare Provider Details

I. General information

NPI: 1477832731
Provider Name (Legal Business Name): DONNA CAROLE THACKER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13737 SPOTSWOOD TRL
ELKTON VA
22827-3200
US

IV. Provider business mailing address

PO BOX 1430
HARRISONBURG VA
22803-1430
US

V. Phone/Fax

Practice location:
  • Phone: 540-713-4100
  • Fax: 757-578-8587
Mailing address:
  • Phone: 540-564-5644
  • Fax: 540-564-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169551
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: