Healthcare Provider Details

I. General information

NPI: 1154667913
Provider Name (Legal Business Name): CRYSTAL MARIE THORNTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E 68TH AVE STE 211
ANCHORAGE AK
99518-2339
US

IV. Provider business mailing address

16825 YELLOWSTONE DR
EAGLE RIVER AK
99577-9404
US

V. Phone/Fax

Practice location:
  • Phone: 907-531-1799
  • Fax: 907-531-1803
Mailing address:
  • Phone: 530-635-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNURU1346
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number34375
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: