| Doctor Name: | MS. AMY JO THORBAHN |
| NPI Number: | 1023354099 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN,BSN |
| License Number: | 490265 - 1 |
| Business Practice Address: | 28 William St Gouverneur, NY - 136421405 |
| Business Phone Number: | 3152872811 |
| Business Fax Number: | 3152874743 |
| Mailing Address: | 28 William St, GOUVERNEUR |
| State: | NY |
| Postal Code: | 136421405 |
| Phone Number: | 3152872811 |
| Fax Number: | 3152874743 |
| NPI Enumeration Date: | 12/20/2012 |
| NPI Last Update Date: | 12/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 490265 - 1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |