Individual
MADELINE ANN THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3600
Mailing address
1538 S 400 E, SALT LAKE CITY, UT 84115-1752
(970) 227-1362
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10122671-4405
UT
363LP0200X
Pediatric Nurse Practitioner
10122671-4405
UT
Other
Enumeration date
06/07/2021
Last updated
07/30/2024
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