Provider Demographics
NPI:1992015861
Name:THYR, KATHLEEN RAE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RAE
Last Name:THYR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 AMERICANA DRIVE
Mailing Address - Street 2:#104
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4898
Mailing Address - Country:US
Mailing Address - Phone:330-928-9333
Mailing Address - Fax:
Practice Address - Street 1:4218 AMERICANA DRIVE
Practice Address - Street 2:#104
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4898
Practice Address - Country:US
Practice Address - Phone:330-928-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.081887-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse