Basic Information
| Provider Information | |||||||||
| NPI: | 1730329376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THAYER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4615 GOVERNMENT ST | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708065820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259220445 | ||||||||
| FaxNumber: | 2259222707 | ||||||||
| Practice Location | |||||||||
| Address1: | 4615 GOVERNMENT ST | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708065820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259220445 | ||||||||
| FaxNumber: | 2259222707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2009 | ||||||||
| LastUpdateDate: | 02/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | RN085064 | LA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent |
No ID Information.