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Individual

THEERARAT THANAVARO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
9512 HARFORD RD, PARKVILLE, MD 21234-3100
(410) 665-4400
Mailing address
421 MATTS WAY, DEFIANCE, MO 63341-2524

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2014015283
MO

Other

Enumeration date
02/16/2015
Last updated
11/24/2020
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