Provider Demographics
NPI:1598001935
Name:THAYER, CHERYL
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOSSY OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-0352
Mailing Address - Country:US
Mailing Address - Phone:207-832-4718
Mailing Address - Fax:
Practice Address - Street 1:296 FOYE RD
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-0352
Practice Address - Country:US
Practice Address - Phone:207-832-4718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker