Individual
HOLLIE MARIE THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 FORD BLVD, LINCOLN PARK, MI 48146-4225
(313) 400-0123
Mailing address
1050 FORD BLVD, LINCOLN PARK, MI 48146-4225
(313) 400-0123
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704278682
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704278682
MI
Other
Enumeration date
07/13/2020
Last updated
02/27/2023
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