Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 2160 | NC |
Y | 213ER0200X | Radiology | 2160 | NC |
NPI | 1659357895 |
---|---|
Provider Name | Dr. Kathy Thorn |
First Address | Wake Forest, NC 27587-8793 |
Second Address | Wake Forest, NC 27587-8793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08817 | BLUE CROSS BLUE SHIELD (01) | NC |
U70339 | (02) | NC |