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General NPI Number Information
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NPI Number | 1437134376
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Entity Type | Individual
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Provider Name | TIMOTHY THACKER CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 06/04/2009
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Provider Practice Location Address
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Address Line | 2951 MAPLE AVENUE
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City | ZANESVILLE
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State | OH
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Zip | 43701-1406
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Country | US
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Telephone | 740-387-6193
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Fax | 740-387-6738
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Provider Business Mailing Address
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Address Line | 945 BETHESDA DRIVE 200B
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City | ZANESVILLE
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State | OH
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Zip | 43701-1406
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Country | US
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Telephone | 740-455-4937
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Fax | 740-455-4931
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 139495
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | COA.00754-NA
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License Number State | OH
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