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Individual
REBECCA THACKER
Active
Individual
REBECCA THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
R062745
AR
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R062745
AR
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
R062745
AR
Other
Enumeration date
04/29/2020
Last updated
06/12/2020
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