Provider Demographics
NPI:1871756189
Name:THRASHER, MARYANN MOULDER (NP)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:MOULDER
Last Name:THRASHER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:100 LACY ST NW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1271
Mailing Address - Country:US
Mailing Address - Phone:770-793-7635
Mailing Address - Fax:
Practice Address - Street 1:4117 S. 240 W. SUITE 200 PROACTIVE MD.
Practice Address - Street 2:NEWTON COUNTY GOV/ SUITE 200
Practice Address - City:MORROCO
Practice Address - State:IN
Practice Address - Zip Code:47963
Practice Address - Country:US
Practice Address - Phone:219-209-4400
Practice Address - Fax:833-525-2450
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GANP174775363LF0000X
GARN174775163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily