MEDICARE: AMBER MICHELLE THORSEN WHNP

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	363LW0102X	Women's Health Nurse Practitioner	5021587	NC

General Provider Information

NPI Number	:	1790599744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MICHELLE THORSEN WHNP

Provider Business Mailing Address
First Line	:	17102 ALYDAR COMMONS LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-8792
Country	:	US
Telephone Number	:	540-797-4723
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 MOREHEAD MEDICAL DR STE 500
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2968
Country	:	US
Telephone Number	:	704-355-3149
Fax Number	:

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

Provider Enumeration Date	:	02/01/2025
Last Update Date	:	04/02/2025

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