Individual provider · Type 1 NPI

Theerarat Thanavaro

Adult Health Nurse Practitioner · Parkville, MD

NPI number 1265823074 Active

Practice location

9512 Harford Rd
Parkville, MD 21234-3100

Mailing address

421 Matts Way
Defiance, MO 63341-2524

Other practice locations

  • 300 Medical Plz Ste 150, Lake St. Louis, MO 63367-1483 · (636) 625-2662

Specialties and licenses

TaxonomyCodeLicense
Adult Health Nurse Practitioner Primary 363LA2200X2014015283 (MO)

Adult Health Nurse Practitioner: Definition to come...

16 other providers at this address

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About NPI 1265823074

Theerarat Thanavaro's National Provider Identifier is 1265823074, issued on Feb 16, 2015. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Parkville, MD. The record was last updated on Nov 24, 2020.