Individual
TIMOTHY THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2951 MAPLE AVENUE, ZANESVILLE, OH 43701-1406
(740) 387-6193
(740) 387-6738
Mailing address
945 BETHESDA DRIVE, 200B, ZANESVILLE, OH 43701-1406
(740) 455-4937
(740) 455-4931
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
139495
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.00754-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0852091
—
OH
Enumeration date
12/14/2005
Last updated
06/04/2009
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