Basic Information
| Provider Information | |||||||||
| NPI: | 1902982903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THATCHER | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LUCAS | ||||||||
| OtherFirstName: | ANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 706 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032640706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034818757 | ||||||||
| FaxNumber: | 6032382163 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 BOULDER POINT DRIVE | ||||||||
| Address2: | SPEARE PRIMARY CARE | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035361181 | ||||||||
| FaxNumber: | 6032382198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 026825-23-03 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 026825-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MT0806591 | 01 | NH | DEA CERTIFICATE | OTHER | 1021535 | 05 | VT | MEDICAID | 026825-23-03 | 01 | NH | ARNP - FNP LICENSE | OTHER | 026825-21 | 01 | NH | RN LICENSE | OTHER | 3078893 | 05 | NH | MEDICAID |