Doctor Name: | MRS. TAMARA KAY THORN |
NPI Number: | 1053606152 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | COA,12381-NP |
Business Practice Address: | 2510 Commons Blvd Suite 210 Beavercreek, OH - 454313820 |
Business Phone Number: | 9374290607 |
Business Fax Number: | 9375583067 |
Mailing Address: | 2510 Commons Blvd, Suite 210 BEAVERCREEK |
State: | OH |
Postal Code: | 454313820 |
Phone Number: | 9374290607 |
Fax Number: | 9375583067 |
NPI Enumeration Date: | 06/16/2011 |
NPI Last Update Date: | 08/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | COA,12381-NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |