=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790599744
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER MICHELLE THORSEN WHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2025
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 MOREHEAD MEDICAL DR STE 500
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28204-2968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-355-3149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17102 ALYDAR COMMONS LN
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28278-8792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-797-4723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 5021587
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------