Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 31714.1236 | WY |
N | 363LA2200X | Nurse Practitioner - Adult Health | 31714.1236 | WY |
N | 363LG0600X | Nurse Practitioner - Gerontology | 31714.1236 | WY |
NPI | 1083624266 |
---|---|
Provider Name | Paula Marie Thornton |
First Address | Cheyenne, WY 82001-3748 |
Second Address | Cheyenne, WY 82001-3748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 02/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
093463100 | (05) | MN |
P24488 | (02) |