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General NPI Number Information
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NPI Number | 1821200544
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Entity Type | Individual
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Provider Name | AMY NICOLE THRASHER D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 4855 S MOORLAND RD FL 3
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City | NEW BERLIN
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State | WI
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Zip | 53151-7494
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Country | US
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Telephone | 262-432-7599
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Fax | 262-432-7694
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE # MS 958
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-7615
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 51832
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License Number State | WI
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