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General NPI Number Information
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NPI Number | 1467944199
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Entity Type | Individual
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Provider Name | JACQUELYN MARIE THAYER
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Gender | Female
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 2006 BAINBRIDGE ST APT 2F
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1373
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Country | US
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Telephone | 267-844-5791
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Fax |
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Provider Business Mailing Address
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Address Line | 2006 BAINBRIDGE ST APT 2F
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1373
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Country | US
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Telephone | 267-844-5791
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 203871
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | THAY-6BQ212
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License Number State | NC
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