Provider Demographics
NPI:1164550737
Name:THACKER, ELSIE LOIS (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:LOIS
Last Name:THACKER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:LOIS
Other - Middle Name:K
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NUSE
Mailing Address - Street 1:80 BOLING RD
Mailing Address - Street 2:P.O. BOX 13
Mailing Address - City:MORRIS CHAPEL
Mailing Address - State:TN
Mailing Address - Zip Code:38361-4028
Mailing Address - Country:US
Mailing Address - Phone:731-687-3176
Mailing Address - Fax:
Practice Address - Street 1:418 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2629
Practice Address - Country:US
Practice Address - Phone:931-722-3644
Practice Address - Fax:931-722-7972
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000106590163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health