=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528445269
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANIA THORNE RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2015
-----------------------------------------------------
Last Update Date | 05/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HWY 86 TOPOWA ROAD
-----------------------------------------------------
City | SELLS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-383-7387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 548 SELLS INDIAN HEALTH HOSPITAL
-----------------------------------------------------
City | SELLS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-383-7387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NR1301X
-----------------------------------------------------
Taxonomy Name | Rural Acute Care Hospital
-----------------------------------------------------
License Number | RN00135886
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------