Healthcare Provider Details

I. General information

NPI: 1922199660
Provider Name (Legal Business Name): VIRGINIA C. THURSTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 W WALNUT ST IB 264
INDIANAPOLIS IN
46202-5181
US

IV. Provider business mailing address

975 W WALNUT ST IB 264
INDIANAPOLIS IN
46202-5181
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-5749
  • Fax: 317-278-1616
Mailing address:
  • Phone: 317-274-5749
  • Fax: 317-278-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: