MEDICARE: NOSLINE THORCHON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1093266173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOSLINE THORCHON

Provider Business Mailing Address
First Line	:	PO BOX 5975
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33466-5975
Country	:	US
Telephone Number	:	561-598-0310
Fax Number	:

Provider Business Practice Location Address
First Line	:	244 LAKE ARBOR DR
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2160
Country	:	US
Telephone Number	:	561-598-0310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	10/24/2016

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Directions to “ NOSLINE THORCHON ” Practice Location

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