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General NPI Number Information
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NPI Number | 1235793639
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Entity Type | Individual
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Provider Name | MEGHAN ELIZABETH THORNBERG PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 211 MAIN ST
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City | WATERVILLE
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State | ME
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Zip | 04901-6117
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Country | US
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Telephone | 207-877-3409
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Fax |
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Provider Business Mailing Address
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Address Line | 226 WATER ST # 2
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City | AUGUSTA
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State | ME
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Zip | 04330-4614
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Country | US
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Telephone | 574-612-4679
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2095
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License Number State | ME
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