Provider Demographics
NPI:1013273523
Name:THRASHER, MICHELLE RAINES (NNP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RAINES
Last Name:THRASHER
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 GULFCREST RD
Mailing Address - Street 2:
Mailing Address - City:CHUNCHULA
Mailing Address - State:AL
Mailing Address - Zip Code:36521-3053
Mailing Address - Country:US
Mailing Address - Phone:251-866-0146
Mailing Address - Fax:
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:DIVISION OF NEONATOLOGY
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-415-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-059530363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal