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Individual

PA NYIA THAO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
123 SHATO LN, MONONA, WI 53716-3795
(715) 451-2084
Mailing address
431 15TH ST N, WISCONSIN RAPIDS, WI 54494-3636

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
322973
WI

Other

Enumeration date
04/06/2019
Last updated
04/06/2019
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