Provider Demographics
NPI:1619741832
Name:THRASHER, CHERMARIE
Entity Type:Individual
Prefix:
First Name:CHERMARIE
Middle Name:
Last Name:THRASHER
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 1:10855 W PARK PL STE 7
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3600
Mailing Address - Country:US
Mailing Address - Phone:262-282-1010
Mailing Address - Fax:414-444-5136
Practice Address - Street 1:4139 N 26TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6619
Practice Address - Country:US
Practice Address - Phone:262-282-1010
Practice Address - Fax:414-444-5136
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care