Provider Demographics
NPI:1164241154
Name:THAYER, LISA (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 N TRUCKEE LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-1570
Mailing Address - Country:US
Mailing Address - Phone:775-742-7697
Mailing Address - Fax:
Practice Address - Street 1:3300 N TRUCKEE LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-1570
Practice Address - Country:US
Practice Address - Phone:775-742-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV881554207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine