Individual
KELLY S THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
501 GOPHER DR, TOMAH, WI 54660-4513
(608) 372-2181
Mailing address
501 GOPHER DR, TOMAH, WI 54660-4513
(608) 372-2181
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2899
WI
Other
Enumeration date
12/20/2006
Last updated
01/19/2021
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