Doctor Name: | ELIZABETH THERKILSEN |
NPI Number: | 1023346798 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | R 111685-4 |
Business Practice Address: | 7901 Bass Lake Rd New Hope, MN - 554283105 |
Business Phone Number: | 7632570130 |
Business Fax Number: | |
Mailing Address: | Po Box 772, Minuteclinic Credentialing, Attn: Kristy Oliver WOONSOCKET |
State: | RI |
Postal Code: | 028950784 |
Phone Number: | 4017701707 |
Fax Number: | 4016529787 |
NPI Enumeration Date: | 11/18/2009 |
NPI Last Update Date: | 12/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R 111685-4 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |