Individual
MYRA JONES THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2308 WESVILL CT, RALEIGH, NC 27607-2949
(919) 781-4311
Mailing address
PO BOX 18139, RALEIGH, NC 27619-8139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
47065
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430001343
RAILROAD-MEDICARE
NC
05
—
8051869
—
NC
Enumeration date
02/21/2007
Last updated
07/08/2007
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