Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 01027885 | IN |
NPI | 1033153507 |
---|---|
Provider Name | Denise K Thornberry |
First Address | Rushville, IN 46173-0608 |
Second Address | Rushville, IN 46173-2126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 19/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000635551 | ANTHEM BCBS (01) | IN |
100346440 | (05) | IN |
D95344 | (02) | IN |