Healthcare Provider Details

I. General information

NPI: 1871843193
Provider Name (Legal Business Name): CHRISTINE R THRASHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMERCE LANE
CANTON NY
13617
US

IV. Provider business mailing address

4 COMMERCE LANE
CANTON NY
13617
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-8191
  • Fax: 315-386-1410
Mailing address:
  • Phone: 315-386-8191
  • Fax: 315-386-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: