Healthcare Provider Details

I. General information

NPI: 1275280836
Provider Name (Legal Business Name): STARLETT ANN THORSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STARLETT ANN JOHNSON

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26645 JONQUIL AVE
ELKO NEW MARKET MN
55020-9594
US

IV. Provider business mailing address

26645 JONQUIL AVE
ELKO NEW MARKET MN
55020-9594
US

V. Phone/Fax

Practice location:
  • Phone: 952-240-9648
  • Fax:
Mailing address:
  • Phone: 952-240-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR131539-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: