| Doctor Name: | ANDREA ETHEL THAYER |
| NPI Number: | 1063827855 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP-PC |
| License Number: | RN.0175673 |
| Business Practice Address: | 2504 Ridge Rd Ste 102 Rockwall, TX - 750872570 |
| Business Phone Number: | 9727711794 |
| Business Fax Number: | 9727711648 |
| Mailing Address: | 2504 Ridge Rd Ste 102, ROCKWALL |
| State: | TX |
| Postal Code: | 750872570 |
| Phone Number: | 9727711794 |
| Fax Number: | 9727711648 |
| NPI Enumeration Date: | 06/30/2014 |
| NPI Last Update Date: | 04/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WN0002X |
| License Number: | RN.0175673 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Neonatal Intensive Care |
| Taxonomy Definition: | |