MEDICARE: TERESA SUE THORPE CNP

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	363LP0200X	Pediatric Nurse Practitioner	NP 07109	OH

General Provider Information

NPI Number	:	1124245493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA SUE THORPE CNP

Provider Business Mailing Address
First Line	:	1671 N LADDIE CT
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2456
Country	:	US
Telephone Number	:	937-426-1032
Fax Number	:

Provider Business Practice Location Address
First Line	:	2912 SPRINGBORO RD WEST
Second Line	:	SUITE 201
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/31/2012

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