Healthcare Provider Details

I. General information

NPI: 1962408898
Provider Name (Legal Business Name): TERRI THORN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0018 COUNTY ROAD 1030 SUITE 125
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 1303
FRISCO CO
80443-1303
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-3633
  • Fax: 970-668-5052
Mailing address:
  • Phone: 970-668-3633
  • Fax: 970-668-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1637
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: