Provider Demographics
NPI:1609179464
Name:THAYER, JENNIFER L
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
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 1:12 VOLZ ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5155
Mailing Address - Country:US
Mailing Address - Phone:802-324-8809
Mailing Address - Fax:
Practice Address - Street 1:12 VOLZ ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5155
Practice Address - Country:US
Practice Address - Phone:802-324-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula