Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 036127325 | IL |
N | 2086S0120X | Pediatric Surgery | 016753 | ME |
N | 2086S0120X | Pediatric Surgery | 036127325 | IL |
N | 2086S0120X | Pediatric Surgery | 246981 | NY |
N | 2086S0120X | Pediatric Surgery | 25MA05751800 | NJ |
N | 2086S0120X | Pediatric Surgery | 28316 | OK |
N | 2086S0120X | Pediatric Surgery | 35-097350 | OH |
N | 2086S0120X | Pediatric Surgery | 49252 | CO |
Y | 2086S0120X | Pediatric Surgery | 77958 | MT |
N | 2086S0120X | Pediatric Surgery | ME 72169 | FL |
NPI | 1366464950 |
---|---|
Provider Name | Dr. Kristine Jane Thayer |
First Address | Roscoe, IL 61073-9612 |
Second Address | Rockford, IL 61103-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 19/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G09507 | (02) | ME |