Provider Demographics
NPI:1053569616
Name:THAYER, LINDA S (RN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:THAYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 HARMONY POINT LN
Mailing Address - Street 2:
Mailing Address - City:BOULDER JUNCTION
Mailing Address - State:WI
Mailing Address - Zip Code:54512-9662
Mailing Address - Country:US
Mailing Address - Phone:715-385-9185
Mailing Address - Fax:
Practice Address - Street 1:4445 HARMONY POINT LN
Practice Address - Street 2:
Practice Address - City:BOULDER JUNCTION
Practice Address - State:WI
Practice Address - Zip Code:54512-9662
Practice Address - Country:US
Practice Address - Phone:715-385-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI166652-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35049500Medicaid