MEDICARE: DR. REBECCA ANN THORSTON DNP, APRN, 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	363LF0000X	Family Nurse Practitioner	6194	MN

General Provider Information

NPI Number	:	1457835043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA ANN THORSTON DNP, APRN, CNP

Provider Business Mailing Address
First Line	:	15428 HUBBELL LN
Second Line	:
City	:	GOOD THUNDER
State	:	MN
Zip	:	56037-2138
Country	:	US
Telephone Number	:	320-583-7082
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E PRINCE ST
Second Line	:
City	:	LAKE CRYSTAL
State	:	MN
Zip	:	56055-2043
Country	:	US
Telephone Number	:	507-726-6966
Fax Number	:

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

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	09/17/2020

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