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General NPI Number Information
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NPI Number | 1326932138
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Entity Type | Individual
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Provider Name | ADAM MICHAEL THAYER RN, BSN
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Gender | Male
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 117 MAIN AVE E STE A
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City | DEER RIVER
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State | MN
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Zip | 56636-8735
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Country | US
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Telephone | 218-246-2250
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Fax | 218-246-2165
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Provider Business Mailing Address
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Address Line | 4100 LEXINGTON AVE N STE 150
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City | SHOREVIEW
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State | MN
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Zip | 55126-3025
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | R-1900549
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License Number State | MN
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