Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 1-059530 | AL |
NPI | 1013273523 |
---|---|
Provider Name | Ms. Michelle Raines Thrasher |
First Address | Chunchula, AL 36521-3053 |
Second Address | Mobile, AL 36604-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 09/04/2012 |