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Jamie Thacker
Family Nurse Practitioner in Mishawaka, Indiana
NPI 1548998131

Jamie Thacker is a Family Nurse Practitioner based in Granger, IN and is specialized in Family. Jamie Thacker practices in Mishawaka, IN. The NPI Number for Jamie Thacker is 1548998131 and holds a License No. 28202077A (Indiana).

The current practice location address for Jamie Thacker is 4630 Vistula Rd, Mishawaka, IN and can be reached out via phone at 574-647-1900 and via fax at 574-647-7289.

Location: 4630 Vistula Rd, Mishawaka, IN, 46530-1380
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1548998131
Provider Name
Jamie Thacker
Credential
Provider Entity Type
Individual
Gender
Female
Address
4630 Vistula Rd, Mishawaka, IN, 46530-1380
Phone Number
574-647-1900
Fax Number
574-647-7289
Provider Enumeration Date
08/11/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
300083152 05 IN
institution
Provider Business Practice Location Address Details
Address
4630 Vistula Rd
City
Mishawaka
State
Indiana
Zip
46544-4000
Phone Number
574-647-1900
Fax Number
574-647-7289
person
Provider Business Mailing Address Details
Address
4630 Vistula Rd
City
Mishawaka
State
Indiana
Zip
46544-4000
Phone Number
574-647-1900
Fax Number
574-647-7289
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
28202077A (Indiana)
Definition
Definition to come...
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