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General NPI Number Information
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NPI Number | 1669153425
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Entity Type | Individual
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Provider Name | MRS. JEANNIE THRASHER
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Gender | Female
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 2424 N 8TH ST
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City | PEKIN
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State | IL
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Zip | 61554-1547
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Country | US
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Telephone | 309-382-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 GINGOTEAGUE WAY
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City | PEKIN
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State | IL
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Zip | 61554-6481
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Country | US
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Telephone | 309-267-5792
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 020.007653
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License Number State | IL
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