Provider Demographics
NPI:1104390798
Name:THAO, BEA (RN)
Entity Type:Individual
Prefix:MS
First Name:BEA
Middle Name:
Last Name:THAO
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 1:2586 7TH AVE E STE 302
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3090
Mailing Address - Country:US
Mailing Address - Phone:612-767-6272
Mailing Address - Fax:612-767-6273
Practice Address - Street 1:2586 7TH AVE E STE 302
Practice Address - Street 2:
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3090
Practice Address - Country:US
Practice Address - Phone:612-767-6272
Practice Address - Fax:612-767-6273
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2464335163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health