Provider Demographics
NPI:1316790157
Name:THURSTON, LAYNE G
Entity type:Individual
Prefix:
First Name:LAYNE
Middle Name:G
Last Name:THURSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SHAFER RD
Mailing Address - Street 2:
Mailing Address - City:CHENANGO FORKS
Mailing Address - State:NY
Mailing Address - Zip Code:13746-2108
Mailing Address - Country:US
Mailing Address - Phone:607-651-3874
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST # 13210
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program