Individual
GWENDOLYN IRENE THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4000 MIAMISBURG CENTERVILLE RD, SUITE 110, MIAMISBURG, OH 45342-7615
(937) 865-9000
(937) 865-9002
Mailing address
4000 MIAMISBURG CENTERVILLE RD STE 110, MIAMISBURG, OH 45342-3674
(937) 865-9000
(937) 865-9002
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
COA.14947-NP
OH
Other
Enumeration date
09/09/2013
Last updated
11/17/2020
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