Healthcare Provider Details

I. General information

NPI: 1255696233
Provider Name (Legal Business Name): KATHRYN HOLBY THORSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/31/2023
Certification Date: 07/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUCK 3RD FLOOR BOWDOIN COLLEGE
BRUNSWICK ME
04011-1747
US

IV. Provider business mailing address

3600 COLLEGE STATION
BRUNSWICK ME
04011-8427
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-3770
  • Fax: 207-725-3905
Mailing address:
  • Phone: 207-725-3770
  • Fax: 207-725-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP121050
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: