MEDICARE: DR. WENDY JO THORN DNP ARNP FNP-C

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	163W00000X	Registered Nurse	60269534	WA
2	363L00000X	Nurse Practitioner	61188657	WA

General Provider Information

NPI Number	:	1437794286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY JO THORN DNP ARNP FNP-C

Provider Business Mailing Address
First Line	:	17526 STATE ROUTE 302 NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-5672
Country	:	US
Telephone Number	:	253-392-5541
Fax Number	:

Provider Business Practice Location Address
First Line	:	17526 STATE ROUTE 302 NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-5672
Country	:	US
Telephone Number	:	253-392-5541
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	01/07/2025

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