Provider Demographics
NPI:1154667913
Name:THORNTON, CRYSTAL MARIE (NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:THORNTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16825 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9404
Mailing Address - Country:US
Mailing Address - Phone:530-635-2619
Mailing Address - Fax:
Practice Address - Street 1:1300 E 68TH AVE STE 211
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2339
Practice Address - Country:US
Practice Address - Phone:907-531-1799
Practice Address - Fax:907-531-1803
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK34375163W00000X
AKNURU1346363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse