Provider Demographics
NPI:1003650441
Name:THAYER, CHERIANNE RENAE (LPN)
Entity type:Individual
Prefix:
First Name:CHERIANNE
Middle Name:RENAE
Last Name:THAYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHERIANNE
Other - Middle Name:RENAE
Other - Last Name:THAYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:909 S 336TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7394
Mailing Address - Country:US
Mailing Address - Phone:253-661-5166
Mailing Address - Fax:
Practice Address - Street 1:909 S 336TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7394
Practice Address - Country:US
Practice Address - Phone:253-661-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP61137553164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse