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NPI Code Detail

MEDICARE: SANDRA C THORNHILL NP

MEDICARE: SANDRA C THORNHILL NP
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
1363L00000XNurse PractitionerRN051026LA

General Provider Information

NPI Number : 1629035860
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA C THORNHILL NP
Provider Business Mailing Address
First Line : 180 N 5TH ST
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-2532
Country : US
Telephone Number : 985-370-7768
Fax Number :
Provider Business Practice Location Address
First Line : 180 N 5TH ST
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-2532
Country : US
Telephone Number : 985-370-7768
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 09/11/2007

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