MEDICARE: NIOLE THAYER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN65574	ME

General Provider Information

NPI Number	:	1174487888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIOLE THAYER RN

Provider Business Mailing Address
First Line	:	300 SOUTHBOROUGH DR STE 120
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-6978
Country	:	US
Telephone Number	:	207-523-3959
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SOUTHBOROUGH DR STE 120
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-6978
Country	:	US
Telephone Number	:	207-523-3959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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