Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 10903 | CA |
NPI | 1184932634 |
---|---|
Provider Name | Shirley Lynn Thorn |
First Address | Grants Pass, OR 97526-3688 |
Second Address | Grants Pass, OR 97526-3688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2010 |
Last Update Date | 01/11/2014 |