Provider Demographics
NPI:1578602835
Name:THAYER, MARY J (MS, ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:THAYER
Suffix:
Gender:F
Credentials:MS, ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:JUDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN
Mailing Address - Street 1:PO BOX 2325
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-2325
Mailing Address - Country:US
Mailing Address - Phone:603-356-3100
Mailing Address - Fax:603-356-7421
Practice Address - Street 1:2977 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5111
Practice Address - Country:US
Practice Address - Phone:603-356-3100
Practice Address - Fax:603-356-7421
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH047901-23-08363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNP4881Medicare ID - Type Unspecified
S04590Medicare UPIN
NHRE3213Medicare ID - Type Unspecified