Individual
LISA THAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(860) 661-6574
Mailing address
155R GUILFORD RD, DURHAM, CT 06422-2815
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6214
CT
Other
Enumeration date
11/12/2015
Last updated
02/01/2021
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