Individual
LISA THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 MILITARY ST, PORT HURON, MI 48060-5416
(810) 985-5437
(800) 248-1568
Mailing address
1953 EMERSON RD, WALES, MI 48027-2120
(586) 484-6657
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
372600000X
ADULT COMPANION
MI
Enumeration date
05/25/2011
Last updated
05/25/2011
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