Individual ProviderLisa ThayerNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9900 Bren Rd E, Minnetonka, MN 55343-9664(860) 661-6574PECOS EnrollmentBased on the most recent information from CMS, provider Lisa Thayer does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1952774093Provider TypeIndividualFull NameThayer, LisaCredentialAGPCNP-BCGenderFemaleSole ProprietorNoEnumeration Date11/12/2015Last Updated2/1/2021Contact InformationPractice LocationPractice Address9900 Bren Rd E, Minnetonka, MN 55343-9664Phone(860) 661-6574FaxUnlisted FaxMailing LocationMailing Address155r Guilford Rd, Durham, CT 06422-2815PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense6214Connecticut