Provider Demographics
NPI:1568127694
Name:THAO, MAI CHOU (RN)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:CHOU
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 1:2810 CROSSROADS DR STE 4000
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-8014
Mailing Address - Country:US
Mailing Address - Phone:608-217-7669
Mailing Address - Fax:
Practice Address - Street 1:2810 CROSSROADS DR STE 4000
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-8014
Practice Address - Country:US
Practice Address - Phone:608-217-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI146818-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse