Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | O16252 | MI |
NPI | 1306809546 |
---|---|
Provider Name | Dena W Thayer |
First Address | Muskegon, MI 49444-1835 |
Second Address | Muskegon, MI 49444-1835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4638958 | (05) | MI |
I2004 | (02) | MI |