Individual
MRS. TAMARA MICHELLE THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
200 MCGEE RD, ANDERSON, SC 29625-2104
(864) 260-2220
(864) 716-2339
Mailing address
124 MALLARD ST, GREENVILLE, SC 29601-4046
(864) 241-1040
(864) 241-8189
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
221103
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629473038
—
SC
05
—
301100
—
SC
Enumeration date
10/28/2014
Last updated
11/18/2024
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