Individual
MRS. ELSIE LOIS THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
418 S MAIN ST, WAYNESBORO, TN 38485-2629
(931) 722-3644
(931) 722-7972
Mailing address
80 BOLING RD, P.O. BOX 13, MORRIS CHAPEL, TN 38361-4028
(731) 687-3176
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN0000106590
TN
Other
Enumeration date
03/02/2007
Last updated
07/08/2007
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