MEDICARE: EUGENIA DEBRAH THORNE FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R179912	MD

General Provider Information

NPI Number	:	1386213429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENIA DEBRAH THORNE FNP-BC

Provider Business Mailing Address
First Line	:	1020 EDGEWOOD RD
Second Line	:
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-1606
Country	:	US
Telephone Number	:	443-356-0007
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 EDGEWOOD RD
Second Line	:
City	:	EDGEWOOD
State	:	MD
Zip	:	21040-1606
Country	:	US
Telephone Number	:	443-356-0007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/05/2024

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