MEDICARE: DENISE R THORNBURG APN

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	APN00038	NV
2	363LN0000X	Neonatal Nurse Practitioner	APN00038	NV

General Provider Information

NPI Number	:	1891805289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE R THORNBURG APN

Provider Business Mailing Address
First Line	:	1848 HEYDON CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-3868
Country	:	US
Telephone Number	:	702-898-1574
Fax Number	:

Provider Business Practice Location Address
First Line	:	3196 S MARYLAND PKWY
Second Line	:	SUITE 217
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2305
Country	:	US
Telephone Number	:	702-733-4944
Fax Number	:	702-733-6507

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/21/2012

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