Provider Demographics
NPI:1245612746
Name:THACKER, MONICA (RN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:THACKER
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 1:1570 WINNEMAC PIKE S
Mailing Address - Street 2:
Mailing Address - City:LA RUE
Mailing Address - State:OH
Mailing Address - Zip Code:43332-8863
Mailing Address - Country:US
Mailing Address - Phone:614-256-2770
Mailing Address - Fax:
Practice Address - Street 1:1570 WINNEMAC PIKE S
Practice Address - Street 2:
Practice Address - City:LA RUE
Practice Address - State:OH
Practice Address - Zip Code:43332-8863
Practice Address - Country:US
Practice Address - Phone:614-256-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH414747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse