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Individual
JEANNE DIANE THACKER
Active
Individual
JEANNE DIANE THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN CNS, FNP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
573554
TX
364SA2200X
Adult Health Clinical Nurse Specialist
573554
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962479774
NPI
TX
01
—
8D0453
MEDICARE PROVIDER NUMBER ISSUED BY CMS 1/2005
—
Enumeration date
03/01/2006
Last updated
12/17/2010
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